How to Get Rid of Head Lice

Getting rid of head lice takes three things: proof that live lice are there, a head lice medicine used exactly as its label directs, and a comb-out every two to three days for the next two to three weeks. The American Academy of Pediatrics calls lice medicine the most effective treatment and says to check with your child’s doctor before you start one. The comb-outs are how you check the work in between.

Lice are a nuisance, not a danger. The AAP says head lice do not put a child at risk for serious health problems, and the CDC’s overview of head lice says they transmit no disease. So the goal is careful, steady work, not panic.

How Do You Know It Is Really Lice Before You Treat?

The best proof is a live louse; if you see none, a nit glued within a quarter inch of the scalp is the next thing to look for. The CDC says finding a live nymph or adult louse on the scalp or hair is the best way to diagnose an infestation, and it also warns that misdiagnosis is common. Nits get confused with dandruff, hair spray droplets and dirt particles; the tell is that a nit is stuck firmly to the hair and the look-alikes are not. The AAP’s method is simple: seat the child in a brightly lit room, part the hair, and work section by section, down to the scalp. The AAP says the easiest places to find them are the hairline at the back of the neck and behind the ears. Live lice are hard to spot because they avoid light and move fast, so a magnifying lens and a fine-toothed louse comb help. Our guide to using a lice comb covers the stroke and the wipe-down between passes. Itching is the most common symptom the CDC lists, along with a tickling feeling, sleeplessness and sores from scratching, but a first or light case can be quiet, and the AAP says it can take four to six weeks before the scalp becomes sensitive enough to itch. If you are not sure what you are looking at, see your healthcare provider before treating.

What Actually Kills Head Lice?

Lice medicine is what kills lice. The CDC’s treatment guidance says you can treat head lice with medications called pediculicides, either over the counter or by prescription, and that they are generally safe and effective when used correctly. It also says plainly that these drugs are insecticides and can be dangerous if misused or overused. The AAP’s instruction is to follow the directions on the package exactly as written, and to call the pediatrician before treatment so you start with a product that fits your child.

A few rules sit outside the label and are easy to miss:

• An adult applies the medicine; never let a child apply it, and never leave a child alone with medicine in their hair
• Do not use conditioner or a combination shampoo and conditioner before lice medicine, and do not re-wash the hair for one to two days after rinsing it out
• Rinse over a sink with warm water, not hot water
• Use one product at a time unless a provider says otherwise, never extra amounts, and keep it out of the eyes
• Do not smoke or use electrical heat sources such as hair dryers, curlers or flat irons, because some of these products are flammable
• Never place anything made of plastic on a child’s head

Home remedies are not a shortcut. The AAP says not to use petroleum jelly, mayonnaise, tub margarine, essential oils or olive oil because no studies prove they work, and the CDC says there is no scientific evidence that suffocating lice with those kinds of substances works. Gasoline, kerosene and medicines made for animals are dangerous and must never be used.

Why The First Treatment Is Not Always The End

Whether you treat twice depends on the product. The CDC says some medicines kill lice and eggs, in which case retreatment is usually not required, while other medicines kill lice but not eggs, in which case a second treatment is recommended about a week later, 7 to 9 days depending on the drug. The point of that second round is to catch the newly hatched lice before they can lay eggs of their own.

Between treatments, the CDC says to check the hair and remove nits and lice every two to three days for the next two to three weeks. Slow-moving lice 8 to 12 hours after treatment are not a reason to reapply, because the CDC says it takes time to kill them all. What does matter is finding no dead lice at all, or lice as active as before, which the CDC says may mean the medicine is not working.

The CDC lists five reasons treatment fails: misdiagnosis, recent use of conditioner or a combination shampoo and conditioner, not following the instructions, lice resisting the medication, and reinfestation after a successful treatment. Resistance is real but uneven. The AAP says lice can be resistant to the active ingredients in over-the-counter treatments in some communities and that the likelihood varies across the country, and it notes that parents sometimes treat up to five times before asking a pediatrician for help. That is the point to stop repeating: the CDC says not to use the same medication more than two or three times if it is not working, and the AAP says to check with your child’s doctor before starting a second or third medicine.

Can You Get Rid Of Lice Permanently?

You can end a case of lice for good, but nothing makes a head immune to the next one. The CDC and the AAP agree that lice spread mainly through close, prolonged head-to-head contact, so another case means new contact, not a treatment that wore off. The CDC lists reinfestation after a successful treatment as one reason families end up back where they started, and it says to check every household member and close contact, then treat everyone who is infested, along with anyone who shares a bed, at the same time.

So “permanently” really means two jobs. The first is finishing this case: no live, crawling lice. The CDC says nits may stay in the hair after treatment while successful treatment kills the crawling lice, and that nits more than a quarter inch from the scalp are almost always hatched or dead. What to do with the nits that stay behind is a separate question from whether the lice are gone, and if you are hoping to be done quickly, we looked at whether lice can really be gone in one day.

The second job is habit. Teach children to avoid hair-to-hair contact during play, and not to share hats, scarves, coats, hair ribbons, barrettes, combs, brushes, towels, headphones, hair ties or helmets. The AAP says regular checks are a good way to spot head lice before they have time to multiply.

What To Clean At Home, And What You Can Skip

Wash what touched the head in the last two days, seal what cannot be washed, and leave the rest alone. The CDC’s list is short: machine wash and dry the clothing, towels, bed linens and other items the person wore or used in the two days before treatment, using the hot water cycle at 130 degrees Fahrenheit and the high heat drying cycle. Items that cannot go in a machine can be sealed in a plastic bag for two weeks or dry-cleaned, and the AAP says you do not need to throw them away. Soak combs and brushes in hot water, at least 130 degrees Fahrenheit, for 5 to 10 minutes. Vacuum the floor and the furniture, particularly where the person sat or lay, and keep heads off beds, couches, pillows, carpets and stuffed animals that an infested person has just used. Then stop: the CDC says spending much time and money on housecleaning is not necessary to avoid reinfestation.

None of this is about how clean your home or your child’s hair is. The CDC says getting head lice is not related to cleanliness, and the AAP says lice attach to anyone’s hair, clean or dirty, a question we took up in whether lice prefer clean or dirty hair.

Frequently Asked Questions

Does a disinfectant spray, fogger or steamer get rid of head lice?

Skip them. The CDC says not to use fumigant sprays or fogs, because they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin, and the AAP says not to spray pesticides in your home: those products expose your family to dangerous chemicals and are not needed when your child’s scalp and hair are treated properly.

How long do head lice live on a mattress, pillows, carpet or stuffed animals?

Not long. The CDC says lice will die within two days if they fall off a person and cannot feed, and the AAP says they cannot survive more than one day without a blood meal. The CDC also calls the risk of getting lice from a louse that has fallen onto a rug, carpet or furniture very small, which is why these surfaces call for a vacuum rather than a fumigation plan.

Can you remove lice by combing alone, without medicine?

Combing alone is not enough. The AAP says the comb-out method usually doesn’t work on its own to get rid of head lice, and the CDC presents nit combs as a way to remove nits and lice from the hair shaft alongside treatment, not instead of it. The CDC adds that flea combs made for cats and dogs work for this too, which can save you a trip.

What does safe lice removal look like at a Lice Lifters clinic?

A check first, then a non-toxic treatment, then a thorough comb-out. Our clinics use an enzyme-based solution that is chemical-free, safe for all ages, and has 99.9% efficacy, and we check the whole family at the appointment because an untreated household member is how a case comes back. It is same-day work, done in one visit, by certified technicians. You can find a Lice Lifters clinic near you.

How do you know when the lice are gone?

When no live, crawling lice turn up on the checks. The CDC says to treat again only if live lice are still there several days after treatment, and the NIH’s MedlinePlus says to keep combing for two to three weeks to be sure all lice and nits are gone. Itching alone is not proof: the AAP says itching from head lice can last for weeks after the lice are gone.

Find A Lice Lifters Clinic

If a home round has already failed, or you would rather not spend two weeks checking heads, our clinics do this work every day. Lice Lifters treatment is non-toxic and safe for all ages, it happens in one visit, and it comes with our 30 Day Guarantee when the whole family is checked. If you are still comparing options, we wrote about how to choose a lice treatment center near you. When you are ready, find a Lice Lifters clinic near you.