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Head lice

Head lice are tiny insects and are slightly smaller than a match head. They can be difficult to see. Lots of children get head lice. It makes no difference whether their hair is clean or dirty. They catch them just by coming into contact with someone who is infested. When heads touch, the lice simply walk from one head to the other. They cannot jump or fly.

Signs of head lice

  • A rash on the scalp.
  • Lice droppings (a black powder, like fine pepper, may be seen on pillowcases).
  • Eggs/nits – the lice lay eggs that are dull and well camouflaged, and hatch after about seven to ten days. Nits are the empty eggshells, about the size of a small pinhead. They are white and shiny and may be found further down the scalp, particularly behind the ears. They may be mistaken for dandruff but, unlike dandruff, they’re firmly glued to the hair and cannot be shaken off.
  • Head itching – this is not always the first sign. Lice have usually been on the scalp for three or four months before the head starts to itch or they may not cause itching.

Checking for head lice

Lice are most easily detected by fine toothcombing really wet hair. Wet your child’s hair and part it about 30 times. Comb each section carefully with a plastic, fine tooth nit comb. This should be done over a pale surface such as a paper towel or white paper, or over a basin of water or when your child is in the bath. Any lice present may be seen on the scalp or the comb, or may fall on the paper or in the water. They are usually grey or brown in colour.

Treatment of head lice

There are two ways of dealing with the problem.

‘Wet combing’ or non-insecticide method

  • Wash the hair in the normal way with an ordinary shampoo.
  • Using lots of hair conditioner and while the hair is very wet, comb through the hair from the roots with a fine tooth comb. Make sure the teeth of the comb slot into the hair at the roots with every stroke.
  • Clear the comb of lice between each stroke with a tissue or paper towel.
  • Wet lice find it difficult to escape, and the hair conditioner makes the hair slippy and harder for them to keep a grip, so that removal with the comb is easier.
  • Repeat this routine every three to four days for two weeks so that any lice emerging from the eggs are removed before they can spread.

Lotions and rinses
Lotions and rinses currently available to treat head lice contain either malathion, phenothrin, permethrin or carbaryl. Lotions containing carbaryl can only be obtained on prescription from your doctor.

The others may be bought from pharmacists or obtained on prescription. Your school nurse, health visitor, pharmacist or GP can advise you on which one to use.

Alternative treatments

‘Natural methods of treating head lice using essential or aromatherapy oils such as lavender, rosemary or tea tree oil, or blends of different oils are popular with some parents. However, little research has been done on their effectiveness or whether these can be toxic if used repeatedly or in the incorrect amount. Some oils can also irritate the skin or may not be suitable for children.

If you do use essential oils to treat head lice it is therefore wise to use these cautiously and not as a preventative measure against lice. It is also known that some essential oils should not be used in pregnancy, so always check that any oil used to treat head lice during pregnancy is safe to use.


One infected child can infect an entire nursery – so do treat your child as soon as you discover head lice.

  • Tell the nursery and other parents.
  • Check your child’s hair regularly, and always check if there is an outbreak at the nursery or school.
  • If your child has head lice, check the whole family (including dad!) and treat them if necessary.
  • Older people, such as grandparents, may have head lice without knowing it and may pass these on to children.
  • Brush and comb your child’s hair often – it may help prevent head lice taking hold.

Treating head lice using lotions or rinses

  • Only use these when head lice have been detected and never as a preventative. A fine tooth plastic comb is better for detection than a metal one.
  • Head lice shampoos are not recommended as they are generally ineffective.
  • Head lice repellants are not recommended.
  • Follow the instructions on how to use the lotion or rinse carefully.
  • To make sure all the head is covered, use an adequate amount of lotion. A minimum of 50 ml is needed for each application.
  • Make a small parting, pour a few drops of lotion on to this and spread over the scalp and hair with the fingers.
  • Repeat this process making small partings systematically about every 2 cm or 1/2 in until the whole head is covered.
  • If after you have rinsed the product off, live lice can still be seen on the head, or seen within a day or two of treatment, the lice may be resistant to the insecticide. In this case, use the ‘wet combing’ method as described, or switch to a product with a different ingredient. If you have used a product containing phenothrin or permethrin do not switch to another product containing either of these as they belong to the same insecticide group.
  • A second application of the same treatment is recommended seven days later.
  • Do not use any product containing malathion or carbaryl more than once a week for three weeks at a time.
  • Once the lice are dead, if you want to remove empty eggshells (‘nits’) from the head, metal tooth combs are best.

We are indebted to Health Promotion England for their help in compiling this section.