If your child has lice, start by confirming what you’re seeing, then treat with a medicated product and follow up with thorough combing. Head lice are incredibly common in school-age kids, they don’t carry disease, and getting rid of them is straightforward once you know the right steps. The whole process takes about two weeks from first treatment to confirmed clearance.
Confirm It’s Actually Lice
Before you buy anything, make sure you’re dealing with lice and not dandruff, lint, or dried hair product. Part your child’s hair in several places and look closely at the scalp. Live lice are dark, about the size of a poppyseed, and they crawl. You’re more likely to spot nits (eggs), which are white or yellowish-brown and sit on the hair shaft about a quarter inch from the scalp.
The simplest test: try to flick the white speck off the hair. Dandruff slides right off. Nits don’t. They’re glued to the strand and resist your fingers. If you find nits cemented to the hair or spot any crawling insects, your child has lice and it’s time to treat.
Choose a Treatment That Works
The most common over-the-counter lice treatments contain either permethrin (sold as Nix) or pyrethrins (sold as Rid, among others). These have been the standard for decades, and here’s the catch: lice in North America have developed significant resistance to them. Studies tracking resistance over the past two decades found that by 2009, nearly 99.6% of head lice in tested populations carried genes making them resistant to pyrethrins and permethrin. That doesn’t mean these products never work, but it does mean there’s a real chance they won’t.
If an OTC product fails after a proper application, your child’s pediatrician can prescribe something stronger. Prescription options work through different mechanisms that resistant lice can’t dodge. These include ivermectin lotion (Sklice), spinosad suspension (Natroba), and benzyl alcohol lotion (Ulesfia). Some of these kill both live lice and eggs in a single application, which simplifies the process considerably.
Whichever product you use, follow the instructions on the box exactly. Most OTC treatments require a second application about 9 to 10 days after the first. This timing matters because it catches any lice that hatched from surviving eggs after the initial treatment.
Comb Out the Nits
Medication alone isn’t always enough. Combining it with thorough wet combing dramatically improves your chances of getting rid of every last louse. Wet combing is also the best way to monitor progress and catch stragglers. Here’s how to do it well:
- Wash and condition. Use regular shampoo, then apply a generous amount of conditioner. The conditioner makes hair slippery, which stuns lice and makes them easier to trap in the comb.
- Detangle first. Work through the wet hair with a wide-toothed comb until it moves freely without dragging.
- Switch to a fine-toothed lice comb. Look for one with teeth spaced less than 0.3 mm apart. Slot the teeth into the hair at the roots, lightly touching the scalp, and draw the comb all the way to the ends with every stroke.
- Check the comb after each stroke. Wipe or rinse it to remove any lice or nits you’ve caught.
- Work section by section. Don’t rush. This takes 10 minutes for short hair and up to 30 minutes for longer hair.
- Repeat a second pass. Once you’ve worked through the entire head and rinsed out the conditioner, comb through again to catch anything you missed.
Repeat this combing session every three days. Keep going until you’ve had four consecutive sessions where you find no lice at all. For most families, that means about two weeks of regular combing.
Clean Your Home (But Don’t Overdo It)
Lice can’t fly or jump. They spread through direct head-to-head contact, and they die within a day or two once they’re off a human scalp. You don’t need to fumigate your house or bag up every stuffed animal in your child’s room. Focus your cleaning on items that touched your child’s head in the two days before treatment.
Machine wash and dry bedding, pillowcases, hats, scarves, and recently worn clothes using hot water (130°F) and the high heat dryer setting. Soak combs and brushes in hot water at 130°F or hotter for 5 to 10 minutes. For items you can’t wash or dry clean, like a favorite stuffed animal, seal them in a plastic bag for two weeks. Any lice or eggs on those items will die without a blood meal long before you open the bag.
Skip the lice sprays for furniture. Vacuuming the couch and your child’s car seat is plenty. Spending hours deep-cleaning your house won’t make a meaningful difference in whether the lice come back.
Skip the Home Remedies
You’ll find plenty of suggestions online for smothering lice with mayonnaise, olive oil, coconut oil, or treating them with tea tree oil, vinegar, or saline spray. Johns Hopkins Medicine is blunt about these approaches: they’re messy, time-consuming, and not supported by scientific evidence. While you’re experimenting with mayonnaise overnight, the lice are still laying eggs. Stick with proven treatments and thorough combing.
Check the Rest of the Family
Once you’ve confirmed lice on one child, check every member of the household the same way. Part the hair, look near the scalp, and try the flick test on any suspicious specks. Only treat family members who actually have lice or nits. Preventive treatment on someone who isn’t infested isn’t necessary and won’t help.
Notify your child’s school or daycare so other parents can check their kids. This isn’t something to be embarrassed about. Lice have nothing to do with hygiene, and letting other families know breaks the cycle of reinfection. If your child’s best friend still has untreated lice, the two of them will pass it back and forth no matter how thoroughly you comb.
What to Do if Treatment Fails
If you’ve completed two rounds of OTC treatment with proper combing and you’re still finding live lice, resistance is the most likely explanation. This is the time to call your child’s pediatrician for a prescription product. Prescription treatments like ivermectin lotion and spinosad work through completely different pathways than the drugstore options, so resistance to one doesn’t mean resistance to the other.
Also double-check your technique. The most common reasons treatment “fails” are applying the product to wet hair when it should go on dry (check your product’s directions), not using enough product to fully saturate the hair, washing hair with a conditioning shampoo right before treatment (the residue can block the medication), or skipping the second application. Getting the details right matters more than which product you choose.