Head Lice :: Nationwide Children's Hospital

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Lice: Treatment and Prevention

Head lice are tiny, 6-legged insects about this long (-). They may be grayish-white, or if they are filled with blood, they will look red. They do not have wings, so they cannot fly. They do not jump but they can move very fast. This makes it hard to find them in the hair. They infect people of all ages and races, but are less common in African American children.

Nits are the eggs of the lice. They look like bits of dandruff in the hair about this size ('). Nits may be yellowish white to brown. Head lice attach their nits to single hair shafts with a waterproof "glue". They are laid close to the scalp. As the hair grows they can be found farther out along the hair shaft. They cannot be washed out or brushed out of the hair. They must be picked or pulled out. Look for nits at the back of the neck and behind the ears.

Lice are passed from child to child by sharing hats, scarves, combs, brushes, hair trims or helmets, or from clothing that has the nits or lice on it. House pets do not carry human lice and should not be treated.

Usually the first sign of head lice is intense itching. The saliva of lice causes itching. If the skin is scratched open, there can be sores that can get infected. The lice and sores must be treated by your doctor. It is VERY IMPORTANT to remove all nits and to treat all family members. To kill the lice and nits, follow these steps:

You Will Need

Regular shampoo without conditioner


A “nit comb” (found at the drug store) or tweezers

Medicated rinse (Nix Creme Rinse®) - available over-the-counter*

1 small plastic bag and tie for nits

2 large plastic bags and twist-ties for clothing and dust

*Note: If your child is allergic to ragweed, check with your doctor before using any other brand of medicated rinse or shampoo. The active ingredient in some other brands such as Rid®, Pronto®, and A-200® could cause a serious allergic reaction.

Using the Nix Creme Rinse

  1. First wash the hair with regular shampoo. Do not use a conditioner. It can keep the lice medicine from working. Rinse with warm water and towel-dry. Do not use this towel again until it has been laundered.
  2. Put enough of the Nix Creme Rinse® to wet your child's hair and scalp completely, especially behind the ears and on the back of the neck. Be careful not to get any Nix Creme Rinse® in your child's eyes. If this happens, rinse the eyes with cool water.
  3. Set a timer for 10 minutes. Leave the rinse on the hair for 10 minutes, but no longer.
  4. Rinse the hair and skin around the scalp well with water. Rub with a fresh dry towel.
  5. It will be easier to remove the nits if you put white vinegar on the hair after you rinse out the Nix Creme Rinse®. Vinegar helps loosen the "glue" that holds the nits to the hair.
  6. Comb the hair with the nit comb to remove nits. All nits must be removed! It might take 2 or 3 hours or more, depending on hair length and the number of nits. You may have to pick out the nits by hand if other methods don’t work. Throw away the nits in a small plastic bag. Tie the bag closed securely.
  7. Wash your hands carefully. Be sure to scrub under your fingernails.
  8. Have your child put on clean clothing.

After the Treatment

  • If you see live lice 10 days or more after the first treatment, a second treatment may be needed. Repeat steps 1 to 8.
  • Check the hair and scalp of all family members every day by combing the hair until no live lice are found for 10 days. If you find nits or lice, treat that family member’s hair and clothing the same way.
  • Don’t use hair conditioner for 10 days.
  • Head lice can live away from the human body for only 55 hours so it's important to follow these directions carefully:

Washable Items

  • Machine-wash in hot, soapy water then dry. Use the hot cycle of a dryer for at least 20 minutes. Wash all washable clothing (including hats, scarves and coats) and all bed linens, towels and washcloths that have had contact with your child in the past 3 days.

  • Soak combs, brushes, hair barrettes, hair bands and sports helmets:

-In hot water (above 130?F) for 10 minutes, or

-In a solution made with the Nix Creme Rinse® for one hour, or

-In rubbing alcohol for one hour, then washed in hot, soapy water.


Picture 1 - Put things that can't be washed in a plastic bag and seal for 14 days. Keep plastic bags away from children.
Image of plastic bag
  • Pillows, stuffed animals, clothing and other things that cannot be washed may be dry-cleaned. Or you can put them in a tightly-sealed plastic bag for 2 weeks (Picture 1). Any nits or lice on these things will die in 14 days.
  • Vacuum all carpets and furniture.  Put the vacuum's dust bag in a plastic bag. Tie tightly before throwing it away.
  • Do not spray insecticides on carpet and furniture.  It is not necessary and could expose children to harmful chemicals.

When to Call the Doctor

  • Your child still has lice after 2 treatments
  • Open, oozing sores on his scalp
  • Fever or enlarged lymph nodes in the neck

School and Other Parents

  • Tell parents of your child's closest friends that their children may also have lice since the children play together.
  • Tell the school nurse at your child's school. The nurse can check other children for nits and make sure they're treated too.
  • Check with your child’s school. In some schools a child’s hair must be free of all nits before he may go back to school. The school nurse should check your child when he goes back.


  • Teach your child to "Never Share What Touches the Hair." He or she should not let anyone else use combs, brushes, hats, scarves, hair accessories, "scrunchies," helmets or pillows and shouldn't borrow them from others either.
  • Check your child's hair often during the school year, especially when the school tells parents there is a lice problem.
  • Have your child bathe or shower every day.  Shampoo the hair 2 or 3 times a week.

If you have any questions, please call __________________ or your local health department.

Lice: Treatment and Prevention (PDF)

HH-I-49 5/76, Revised 9/11 Copyright  1976-2011, Nationwide Children’s Hospital

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