If your child has head lice, start treatment the same day with an over-the-counter lice shampoo, then follow up with thorough combing and a second treatment about nine days later. Lice are not dangerous and don’t carry disease, but they won’t go away on their own. The good news: with the right approach, most cases clear up within two weeks, and your child doesn’t need to miss school.
Confirm It’s Actually Lice
Before you treat anything, make sure you’re dealing with lice and not dandruff or dry scalp. Look close to the scalp, about a quarter inch from the skin, for tiny white or yellowish-brown oval shapes attached to individual hair strands. These are nits (lice eggs). The simplest test: try to flick or pull the speck off the hair. Dandruff comes off easily. Nits don’t. They’re cemented to the hair shaft and require real effort or a fine-toothed comb to remove.
You may also spot live lice, which are tan or grayish-white and about the size of a sesame seed. They move fast and avoid light, so parting the hair in sections under a bright lamp gives you the best chance of seeing them. Check behind the ears and along the neckline first, since lice prefer warm spots near the skin.
Start With an Over-the-Counter Treatment
Two types of lice-killing products are widely available at pharmacies. One contains pyrethrins (derived from chrysanthemum flowers), approved for children age two and older. The other contains 1% permethrin lotion, a synthetic version of the same compound, approved for children as young as two months. Both kill live lice but not unhatched eggs, which is why a second treatment is essential.
Apply the product to dry or towel-dried hair according to the package directions, let it sit for the recommended time, then rinse. Do not use regular conditioner before applying the treatment, as it can reduce effectiveness.
There’s an important caveat, though. Lice resistance to these products is remarkably high. A 2021 global analysis found that roughly 77% of head lice populations carry genetic resistance to pyrethrins and permethrin. In North America specifically, resistance rates reached above 99% in some studies between 2007 and 2009, and the trend has not reversed. So if your child still has live lice two to three days after the first treatment, the product likely isn’t working, and you’ll need to try a different approach.
Why the Second Treatment Matters
Neither over-the-counter option kills nits. Eggs hatch in about seven to ten days, so the second treatment targets newly hatched lice before they’re old enough to lay their own eggs. For pyrethrin products, apply the second round nine to ten days after the first. For permethrin, day nine is the standard recommendation. Skipping this step is one of the most common reasons lice come back.
Wet Combing: The Most Reliable Tool
Whether or not you use a medicated product, wet combing with a fine-toothed lice comb is the backbone of treatment. You need a comb with teeth spaced less than 0.3 millimeters apart to trap both adult lice and smaller nymphs. Metal combs generally work better than plastic for removal, though plastic combs can be gentler for detection.
Here’s how to do it: wash your child’s hair with regular shampoo, then apply a generous amount of ordinary conditioner. The conditioner slows the lice down and makes it easier to pull the comb through without tangles. Work through the hair in small sections from the scalp to the tips, wiping the comb on a white paper towel after each pass so you can see what’s coming out. The whole process takes 5 to 15 minutes depending on hair length and thickness.
Repeat wet combing every two to three days for at least two weeks. This catches any lice that hatch between sessions. Some families use wet combing alone, without any chemical treatment, and it works well when done consistently. It just requires patience and thoroughness.
What to Do If Standard Products Fail
Given the high resistance rates, it’s common for over-the-counter treatments to fall short. If you’re still finding live lice after the second application, you have two paths.
The first is a non-toxic suffocation method. A clinical trial published in the journal Pediatrics tested a technique using Cetaphil Gentle Skin Cleanser applied to dry hair, combed through to coat every strand, then blow-dried until completely dry. The dried cleanser forms a shrink-wrap-like layer that suffocates lice overnight. It’s washed out the next morning. Repeated once a week for three weeks, this method achieved a 96% cure rate across 133 participants, with 94% still lice-free at follow-up. It uses no neurotoxins and the study found that nit removal wasn’t even necessary for it to work.
The second path is a prescription treatment from your child’s pediatrician. Prescription options use different mechanisms that bypass the resistance problem affecting store-bought products. These are typically single-application treatments that don’t require a second round or nit combing, making them more convenient for stubborn cases.
Cleaning Your Home (Without Overdoing It)
Lice die within two days of falling off a human head because they can’t feed. That means your home doesn’t need to be deep-cleaned from top to bottom. Focus on items that touched your child’s head in the past 24 to 48 hours.
- Bedding and recently worn clothes: Wash sheets, pillowcases, blankets, and any clothing worn in the past 24 hours on the hottest water setting recommended for the fabric. Dry on the hottest dryer setting.
- Items that can’t be washed: Toss pillows, stuffed animals, or quilts in the dryer on high heat for 20 to 30 minutes. Alternatively, seal them in a plastic bag for two weeks (any lice or nits will die without a host).
- Brushes and hair accessories: Soak combs, brushes, and hair ties in hot water (at least 130°F) for 10 minutes.
You do not need to bag up every stuffed animal in the house, spray furniture with pesticide, or shampoo your carpets. Lice spread almost exclusively through direct head-to-head contact, not by hopping off furniture or floating through the air. They can’t jump or fly.
Your Child Can Still Go to School
Both the American Academy of Pediatrics and the National Association of School Nurses recommend against “no-nit” policies that keep kids home until every last egg is removed. Their reasoning is straightforward: nits found more than a quarter inch from the scalp are almost certainly dead or already hatched, nits don’t transfer from person to person, and the missed school days cause more harm than the lice themselves. Misdiagnosis during school nit checks is also extremely common.
The current guidance is simple. If lice are found during the school day, your child can stay through the end of the day, get treated at home that evening, and return to class the next morning. Many schools still enforce outdated no-nit rules, but the medical consensus has moved on.
Preventing Reinfection
Check every member of your household the same day you find lice on your child. Treat anyone who has live lice or nits within a quarter inch of the scalp. If only one child is treated while a sibling quietly carries lice, the cycle restarts within days.
Teach your child not to share hats, helmets, brushes, or hair accessories. For sleepovers, bring their own pillow. Beyond that, there’s no guaranteed prevention. Lice don’t discriminate based on hygiene, hair type, or income level. Clean hair gets lice just as easily as unwashed hair. If your child picks up lice again a few weeks later, it’s not a failure of cleaning. It almost always means re-exposure through head-to-head contact at school or activities.