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The Signs | Where Do the Little Critters Come From? | No School? | How to Get Rid of the Little Critters | Beware Unproven Treatments | Tips for Preventing Head Lice | Keep Checking

Preschool and elementary school children and their families are among those at the greatest risk of exposure to head lice. Girls get head lice more often than boys and women more than men. Head lice is most often found on the scalp behind the ears and near the neckline at the back of the neck. The lice hold onto hair with the hook-like claws they have at the ends of each of their six legs.

The Signs

How do you know if your child has head lice? These signs are a good indication:

  • Feeling of tickling or crawling in hair
  • Itching or scratching
  • Irritability, especially at night
  • Sores on the head due to scratching
  • Eggs or lice seen in the hair

Other symptoms of head lice may include fever, headache, rash, and swollen lymph nodes.

Where Do the Little Critters Come From?

The most common causes of head lice include:

  • Having contact with an already infested person during play at school or home
  • Using infested combs, brushes, or towels
  • Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person

No School?

While some experts recommend that children miss school and parents miss work due to head lice, others do not. Each school district has its own policies, so check with the officials at your child's school.

How to Get Rid of the Little Critters

When you find head lice, spring into action as quickly as you can. Your first priority should be to get rid of lice eggs, called nits, in order to end the life cycle.

If your doctor recommends a shampoo, follow the directions carefully. Then wash all bedding and clothing in hot water and dry them in a dryer using high heat. Vacuum floors, beds, chairs, car seats, and headrests—any place that the person with lice has been. Soak combs and brushes in hot water for 5-10 minutes.

It is important to use appropriate products to treat lice.

Examples of medicines used to treat head lice include:

  • Over-the-counter products, such as those containing pyrethrin or permethrin
  • Prescription products, such as lindane and malathione—These may be prescribed because some cases of head lice are resistant to pyrethrin and permethrin.

The Food and Drug Administration (FDA) includes a warning on prescription shampoos and lotions containing lindane because, in rare cases, it can cause serious side effects, including seizure and death. Those especially at risk include:

  • Infants
  • Children
  • Elderly
  • People weighing less than 110 pounds
  • People with certain skin conditions

If you are given a prescription for lindane, carefully follow the instructions. For more information, visit http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProvi...s/ucm110848.htm .

A fine-toothed comb designed to capture and remove the lice and nits often comes with the medicated shampoo. A lice comb is the standard for lice detection and removal. The teeth of the comb should be long and tapered and set so close that combing removes virtually all lice and nits. This comb can be used to check for the presence of the lice after treatment

Beware Unproven Treatments

There are many unproven head lice remedies. The biggest problem with using these herbs is that if they do not work, the head lice population can increase unchecked, worsening the infestation and associated symptoms.

Some herbal remedies, though, have shown to be effective in clinical trials. An example is a spray that contains coconut oil and anise. If you are unsure of which product to use, talk to your doctor.

Others are experimenting with suffocating the head lice by covering the hair with mayonnaise or olive oil and wrapping the head in plastic wrap overnight. There is no evidence that these methods work either. The multiple shampooing required to remove the oil from the hair can also irritate an already itchy head.

Tips for Preventing Head Lice

There are ways to prevent getting head lice. Some steps you can take include the following:

  • Avoid head-to-head contact
  • Do not share clothing or hair accessories
  • Do not share combs, brushes, or towels

Keep Checking

Some people report that despite vigilance and treatment, the lice keep coming back. Be sure to continue checking for lice regularly. If the treatment did not work, let your doctor know as another medicine may need to be used. As much as no one wants to reveal that they have head lice, it is important to warn friends who may have been exposed. After spending weeks to eliminate the lice, you do not want your child to pick it up all over again from his pals.


Centers for Disease Control and Prevention (CDC)


National Institute of Allergy and Infectious Diseases



Communicable Disease Control (CDC) Network

Province of Manitoba



Dodd CS. Interventions for treating head lice. Cochrane Database Syst Rev. 2001;(2):CD001165. Review.

FDA Public Health Advisory: safety of topical lindane products for the treatment of scabies and lice. Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110845.htmUpdated April 30, 2009. Accessed February 11, 2013.

Head lice. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 26, 2012. Accessed February 11, 2013.

Head Lice. Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/parasites/lice/head/index.html. Last updated November 2, 2010. Accessed February 11, 2013.

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Lindane. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 11, 2013.

Meinking TL, Serrano L, Hard B, Entzel P, Lemard G, Rivera E, Villar ME. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138(2):220-224.

Mumcuoglu KY. Prevention and treatment of head lice in children. Paediatr Drugs. 1999;1(3):211-218.

Richardson M, Elliman D, Maguire H, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J. 2001;20(4):380-91.

12/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169(1):55-62.

Last reviewed February 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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