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Starting preschool or kindergarten is so exciting! Your little one will embark on a new journey, learn so many new things, and make tons of new friends. But there’s one “little buddy” that kids this age tend to pick up that’s, well, less than exciting: lice! In fact, each year between 6 and 12 million 3- to 11-year-olds experience head lice in the U.S., according to the Centers for Disease Control and Prevention (CDC). And most of those cases are among preschoolers and elementary school students—and everyone in their households. (Yikes!) But before you panic (or get phantom scalp itches), it's a good idea to learn everything you can about lice, including how to spot lice, how to protect your preschooler from lice, and how to safely treat lice in toddlers, preschoolers—even babies.

What are head lice?

Head lice are parasitic insects that live on your head (and sometimes eyebrows and eyelashes) and (gulp) feed off your blood. While these teeny tiny buggies don’t spread disease, they often cause itchiness, embarrassment, and distress.

What do lice look like?

Not all lice look the same! That’s because head lice have three forms: egg, nymph, and adult. Here’s what each one look like:

  • Lice eggs (aka nits): Nits are oval and often look yellow or white, but can also mirror the color of the hair they’re in. You can find them no more than a quarter inch from the base of the hair shaft…that is if you can find them! Nits are about the size of a knot in thread (0.8 mm long and 0.3 mm wide), so they’re hard to see. While nits look like dandruff, you can’t easily brush or shake them off hair, like you can with dandruff.

  • Lice nymph: Nymphs are baby louse that have recently hatched. They’re about the size of a pinhead, have six legs, and are grayish-white or tan. These buggers remain nymphs for 9 to 12 days until maturing into an adult louse.

  • Adult lice: A fully-grown six-legged louse is about the size of a sesame seed and appears tan to grayish white, but they can sometimes look darker if residing in dark hair. An adult bloodsucker can live about 30 days on the scalp—and females can lay about six lice eggs a day.

How does lice spread?

Toddlers, preschoolers, and elementary school kids spend a lot of up-close-and-personal time together in large groups playing on the floor, wrestling, having sleepovers, sharing stories, playing tag, and more. That means, there’s oodles of opportunities for head-to-head contact, making it super easy for lice to crawl from one child to the next. With that, it’s important to know…

  • Lice is spread from close, prolonged head-to-head contact.

  • Lice cannot fly or jump.

  • Lice is rarely spread by sharing combs, brushes, hats, or helmets.

  • Lice has nothing to do with hygiene.

  • Pets can’t catch or give you head lice.

  •  Head lice cannot live off their human host for more than a day.

Symptoms of Head Lice

Far and away, the most common symptom of head lice is itching, especially behind the ears and near the back of the head and neck. But it may take up to 6 weeks after infestation before the itchiness kicks in! While the itch is a reaction to lice saliva, the feeling can actually last for weeks, even after the lice are gone. A scratchy scalp isn’t the only symptom of head lice. Here, lice signs to look out for:

  • Intense itching

  • Tickly feeling on the scalp

  • Sores or bumps on the scalp from scratching

  • Difficulty sleeping (Lice are most active in the dark.)

  • Swollen glands on the back or front of the neck (Scratching can lead to an infection.)

How to Check for Lice

The American Academy of Pediatrics (AAP) suggests parents check for head lice regularly, so that you have a shot at spotting creepy crawlers before they cause a full-blown infestation. But be warned: Head lice move fast and scurry away from light, so it’ll be easier to spot nits. (A typical affected scalp will have fewer than 10 live lice.) Grab a magnifying glass and a fine-toothed comb, and check for lice this way:

  • Do your lice check in a brightly lit room.

  • Part your child’s hair in several spots with a fine-toothed lice comb.

  • With the help of a magnifying glass, look for nits and crawling lice on the scalp, behind the ears, and around the nape of the neck.

  • Pull on any nits you believe you see. If it’s a nit, it’ll stay stuck. If it’s dandruff or dirt, you can easily remove it.

If you don’t see any crawling lice, but you do see nits super-glued to hair within a quarter inch of the scalp, that’s a strong indication of an infestation, according to the CDC. If you spy zero live lice—and the only nits you see are more than a quarter-inch from the scalp—there’s a good chance that the lice infestation is no longer active and doesn’t need treatment.

If you’re unsure if your child has head lice, call your healthcare provider who’ll be able to check your child and diagnose head lice. That’s important because you should only use head lice treatment if you’re absolutely certain your child has living head lice, and misdiagnosis of head lice infestation is common,” notes the CDC. Research shows that roughly 40% of presumed lice cases flagged by teachers, caregivers—even healthcare professionals—were really just evidence of dandruff, hairspray droplets, scabs, dirt, or other insects that were blown into the hair. All this misdiagnosing of head lice leads to treatment that’s simply unnecessary. 

Will my child’s daycare or school screen for lice?

Not always. In fact, fewer schools and daycare facilities are screening for lice these days—and that’s a good thing, according to the AAP, which discourages routine classroom and school-wide lice screenings. Research has found that screening for lice in school is ineffective at spotting lice and doesn’t have a significant impact on lice outbreaks in schools. For example, one study found that only 18% of children flagged for nits in school actually had an active infestation during 14 days of observation.

Should children with lice stay home from daycare or school?

No. The CDC attests that kiddos diagnosed with live head lice don’t need to be sent home early from school. Instead, they can go home at the end of the day, like everyone else, get treated for lice, and then return to school or daycare after treatment starts. At the same time, neither the AAP nor the National Association of School Nurses supports “no-nit” policies in schools and daycares. (A “no-nit” policy means a child needs to be 100% free of nits before they can return to school.) Instead, instruct your little one to avoid head-to-head contact with their classmates and to not share hats or hairbrushes. If your child has long hair, consider putting it up a bun, braid, or ponytail.

How to Treat Lice in Babies, Toddlers, and Preschoolers

Remember, it’s very important to only initiate lice treatment if your child is experiencing an active lice infestation. (That means, crawling lice have been spotted.) That’s why the AAP recommends checking with your child’s doctor before beginning treatment. If you’re pregnant, ask your healthcare provider if it’s safe to handle lice shampoo. With that, here’s your age-by-age guide to FDA-approved lice treatment options:

Lice Treatment for Children 2 Months and Older

  • Permethrin lotion: OTC lice treatments, like Nix, Elimite, and Acticin, contain 1% permethrin and are designed to kill lice, but not nits. You’ll need to apply the treatment to shampooed (not conditioned) and towel-dried hair. Let it sit for 10 minutes, then rinse. (Don’t shampoo for 24 to 48 hours afterward.) You’ll need to retreat between days 9 and 10 later if live lice are seen.

Lice Treatment for Children 6 Months and Older

  • Ivermectin lotion: The OTC product Sklice is 0.5% ivermectin lotion. This lice treatment kills lice, but not eggs, but it does prevent newly hatched lice from surviving. Apply Sklice to dry hair, rinse after 10 minutes, and don’t shampoo for 24 to 48 hours after treatment. (Here, only one application is needed.)

  • Spinosad topical suspension: Sold as Natroba, this 0.9% spinosad topical suspension treatment is prescription-only and it’s designed to eradicate both live lice and nits. You’ll need a second treatment in 7 days if live lice are still there. (Apply to dry hair and rinse after 10 minutes. Refrain from shampooing for 24 to 48 hours afterward.) It’s important to know that prescription lice treatment may not be covered by health insurance.

Lice Treatment for Children 2 Years and Older

  • Pyrethrin-based products: RID, A-200, Pronto, R&C, Triple X, and Licide are all OTC pyrethrin-based shampoos or mousses that kill lice, not nits. Apply to dry hair and rinse after 10 minutes. (Don’t shampoo for 24 to 48 hours afterward.) Retreatment is recommended between days 9 and 10.

Lice Treatment for Children 4 Years and Older

  • AirAllé: This device is an FDA-cleared hot air treatment for lice. One 30-minute hot air regimen from a trained professional can zap nearly 100% of nits and 80% of lice. (A regular hair dryer does not duplicate these results!)

Lice Treatment for Children 6 Years and Older

  • Malathion lotion: Ovide (0.5% malathion lotion) is a prescription lice treatment that kills both lice and nits. You apply to dry hair and leave it for 8 to 12 hours before rinsing. Don’t shampoo for 24 to 48 hours afterward. This treatment is pretty stinky and will need to be reapplied after 7 to 9 days if live lice are spotted. PS: Ovide is super flammable, so never use a hair dryer post-treatment.

No matter which lice treatment you choose, wear gloves when applying, stay with your child while the medicine is on their hair, don’t put a shower cap on your child’s head, and have them put on clean clothing afterward. Delousing your kiddo is likely not enough! The AAP recommends all members of your household (and close contacts) get checked and treated for head lice if necessary. If you still find lice after two rounds of an OTC treatment, talk to your child’s pediatrician to see if a prescription might be the best next step.

Can lice be resistant to treatment?

It’s true that lice can be resistant to the active ingredients in OTC lice treatments—in some communities. (When head lice are resistant, that means OTC treatments may not work.) Because the chances of lice treatment resistance vary across the country, it’s smart to connect with your pediatrician about resistance in your area.

Do natural lice treatments work?

You might be asking yourself, What about natural lice remedies? The AAP greatly discourages the use of any herbal or essential oil lice treatments on infants, children, and adolescents. While there may be some anecdotal evidence around the effectiveness of butter, margarine, mayonnaise, olive oil, or petroleum jelly to treat lice, they have not shown to be as effective FDA-approved head lice treatments. However, there is some evidence that applying Cetaphil to hair, blow-drying it, leaving it on overnight, washing out the next morning—and then repeating this once a week for three weeks may yield a 96% “cure” rate  Again, this is not approved by the FDA for lice treatment. If lice medicine has not worked to kill your child’s lice and you’d like to try these methods, consult your physician.

What is the comb-out method for lice?

The comb-out method (aka manual removal) is the only lice treatment option for children under 2 months old. It’s also how you check for nits and lice—and how you remove nits and lice after lice treatment. (This strategy is usually done in conjunction with OTC or prescription lice treatment.)

Here’s how you do the comb-out method:

  • Wet and condition your child's hair.

  • Use a fine-tooth louse/nit comb to comb through your child’s hair in small sections.

  • After each swipe of the comb, wipe the comb on a wet paper towel.

  • Repeat until you've combed through all your bub’s hair. (It’s suggested that you repeat this every 3 to 4 days for 3 weeks after the last live louse was seen.)

How do you prevent head lice naturally?

The harsh truth, straight from the AAP, is that it's unlikely that you can prevent all head lice infestations. But you can take some steps to help curb the spread of lice, such as…

  • Soak combs and brushes. Although it’s rare for lice to be spread by combs and brushes, 5- to 10-minute soak in water at least 130 degrees Fahrenheit can help disinfect combs and brushes used by a kiddo with lice.

  • Vacuum the floor and furniture. Even though lice survive less than or two days after they fall off the scalp, it’s a good idea to vacuum the spots in your home where your child with lice gravitates to.

  • Launder clothes and sheets. It’s recommended that you wash and dry all items that your child has been in contact with in the 48 hours before lice treatment. Use hot water and the high-heat dry cycle. Dry-clean items that cannot be washed—or seal them in a plastic bag for two weeks.

  • Avoid head-to-head If a member of your household is dealing with lice, you’ll want to avoid hair-to-hair contact during play, sleep, and cuddling.

  • Skip lice repellents. Harvard researchers note that lice repellents are not effective and may not be safe.

 

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REFERENCES

  • Centers for Disease Control and Prevention (CDC): Head Lice, Frequently Asked Questions (FAQs)
  • Nemours Children’s Health, KidsHealth: Head Lice
  • S. Food and Drug Administration (FDA): Treating and Preventing Head Lice
  • American Academy of Pediatrics (AAP): Head Lice: What Parents Need to Know
  • Head Lice. September 2022
  • Quality Improvement Projects Related To Pediculosis Management. The Journal of School Nursing. April 2002
  • CDC: Head Lice, Diagnosis
  • Overdiagnosis and consequent mismanagement of head louse infestations in North America. The Pediatric Infectious Disease Journal. August 2020
  • CDC: Head Lice Information for Schools
  • National Association of School Nurses: Head Lice Management in Schools
  • Nationwide Children’s: Head Lice
  • AAP: Head Lice Treatment Myths & Realities
  • A simple treatment for head lice: dry-on, suffocation-based pediculicide. Pediatrics. September 2004
  • IdentifyUS: Can anything repel lice?

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    Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.