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Pediatric - Head Lice

Lice - head

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Head Louse (Female)
Head Louse (Female)

Head Lice - Searching Hair
Head Lice - Searching Hair

Head Lice Size Compared to a Penny
Head Lice Size Compared to a Penny

  • A scalp infection with tiny gray bugs called lice


  • Itching of the scalp is the main symptom.
  • A scalp rash may be present. The back of the neck is the favorite area.

Lice and Nits

  • Lice are 1/16-inch long, gray-colored, move quickly, and are difficult to see.
  • Nits are white eggs firmly attached to hair shafts near the skin. Unlike dandruff or sand, nits can't be shaken off the hair shafts.
  • The nits are easier to see than the lice because they are white and very numerous.

Lifespan of Lice

  • Nits (eggs) that are over ½ inch from the scalp are empty egg cases and very white in color.
  • The nits (eggs) hatch into lice in about 1 week.
  • Off the scalp, nits can’t survive over 2 weeks.
  • Adult lice survive 3 weeks on the scalp or 24 hours off the scalp.


  • A tiny insect the size of a sesame seed

Return to School

  • Your child can return to day care or school after 1 treatment with the anti-lice shampoo.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • Age under 2 months old (Reason: have your doctor recommend the safest lice medicine)
  • Scalp looks infected (e.g., pus, soft scabs, open sores)
Call Your Doctor During Weekday Office Hours If
  • You think your child needs to be seen
  • Diagnosis of head lice is uncertain
  • New head lice or nits appear after treatment
  • Scalp rash or itch lasts over 7 days after treatment
  • You have other questions or concerns
Parent Care at Home If
  • Head lice and you don't think your child needs to be seen

  1. Reassurance:
    • Head lice can be treated at home.
    • With treatment, all lice and nits are usually killed.
  2. Nix: Buy Nix anti-lice creme rinse (over-the-counter) and follow package directions.
    • First, wash the hair with a regular shampoo and towel dry it before using the anti-lice creme. Do NOT use a conditioner or creme rinse after shampooing (Reason: interferes with NIX).
    • Pour 2 ounces (full bottle) of Nix into damp hair. People with long hair may need to use 2 bottles.
    • Work the creme into all the hair down to the roots.
    • If necessary, add a little warm water to work up a lather.
    • Nix is safe above 2 months old.
    • Leave the shampoo on for a full 10 minutes or it won't kill all the lice. Then rinse the hair thoroughly with water and dry it with a towel.  
    • Repeat the anti-lice shampoo in 1 week to kill any nits that survived.
  3. Remove the Dead Nits:  
    • Remove the dead nits by backcombing with a special nit comb or pull them out individually.  
    • Even though treated nits are dead, some schools will not allow children to return if nits are present.
  4. Hairwashing Precautions to Help Nix Work:
    • Don't wash the hair with shampoo until 2 days after lice treatment
    • Avoid hair conditioners before treatment and for 2 weeks afterwards (Reason: coats the hair and interferes with Nix)
  5. Contagiousness of Lice:  
    • Lice are transmitted by close contact (they cannot jump).
    • Your child can return to day care or school after 1 treatment with the anti-lice shampoo.  
    • Check the heads of everyone else living in your home.  If lice or nits are seen, or someone has the new onset of an itchy scalp rash, they also should be treated with anti-lice shampoo.
    • Bedmates of children with lice should also be treated.  If in doubt, have your child examined for lice.
    • Re-emphasize not sharing combs and hats.  
    • Also notify the school nurse or day care center director so she can check other students in your child's class/center.
  6. Cleaning the House:
    • Lice that are off the body rarely cause reinfection. (Reason: lice can't live for over 24 hours off the human body.) Just vacuum your child's room.
    • Soak combs for 1 hour in a solution containing some anti-lice shampoo.
    • Wash your child's sheets, blankets, pillow cases, and any clothes worn in the past 3 days in hot water (140° F kills lice and nits).
    • Items that can't be washed (e.g., hats, coats, or scarves) should be set aside in sealed plastic bags for 2 weeks (the longest period that nits can survive).
  7. Expected Course:
    • With treatment, all lice and nits will be killed.
    • A recurrence usually means another contact with an infected person or the shampoo wasn't left on for 10 minutes or the treatment wasn't repeated in 7 days.
    • There are no lasting problems from having lice and they do not carry other diseases.
  8. Call Your Doctor If:
    • New lice or nits appear in the hair
    • Scalp rash or itch lasts over 1 week after the anti-lice shampoo
    • Sores on scalp start to spread or look infected
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 8/9/2007

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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