Head lice in kids: how to check, comb them out and stop the spread

Head lice in kids are common, and you can usually clear them at home with conditioner and a fine-toothed nit comb. KKH says head lice usually affect children aged 3 to 12. They don't spread disease, and the US CDC says catching them has nothing to do with how clean your child or your home is. Start combing the day you find them.

How to check for and treat head lice, step by step

1. Sit your child in a brightly lit spot, as the American Academy of Pediatrics (AAP) suggests. Nits are easiest to find at the hairline at the back of the neck and behind the ears.
2. Wash the hair with ordinary shampoo, then put on lots of conditioner. The UK's NHS says any conditioner will do.
3. Comb from the roots to the ends with a fine-toothed nit comb, one small section at a time. Wipe the comb on a wet paper towel after each stroke and check it for lice.
4. Comb the whole head a second time. The NHS says each round takes about 10 minutes for short hair and 20 to 30 minutes for long, frizzy or curly hair.
5. Treat only when you find a live louse. The NHS says live lice are how you know for sure, and the AAP keeps lice medicine for a child who has living lice.
6. Check everyone you live with on the same day. The NHS says to start treating anyone who has lice that same day.
7. Repeat the wet combing on days 1, 5, 9 and 13, then check everyone again on day 17. That's the NHS schedule, and it catches lice that hatch from eggs you missed.
8. Ask a pharmacist about a lice lotion or spray if combing hasn't cleared them. Skip conditioner on lotion day, because conditioner used just before can stop lice medicine working, CDC says.
9. Wash the pillowcases, towels, hats and clothes your child used in the two days before treatment, as CDC advises. Seal anything you can't wash in a plastic bag for two weeks.
10. Tell your child's preschool or school, and any grandparent or helper who looks after them.

Nits, lice or dandruff: what you're looking at

Live lice are hard to catch sight of. The AAP says they avoid light and move quickly, so the eggs are often what you see first. Lice attach these eggs, called nits, to the hair close to the scalp.

Not sure what you've found? Ask your child's doctor or school nurse, as Cleveland Clinic suggests. A nit comb is worth adding to your home medicine and first aid kit.

Wet combing or a lotion: what to try first

Combing uses no medicine, so most families start there. The NHS suggests a medicated lotion or spray if combing hasn't worked or doesn't suit your child, and a pharmacist can help you choose. Your child's age matters: KKH's page lists one treatment as safe from one month of age and another only from one year. Lice can also resist some medicines, which CDC gives as one reason a treatment fails.

How long the product stays on, and whether you repeat it, comes from the label. The NHS says some treatments need a second round after a week to kill newly hatched lice. Once you have a lotion, the AAP sets out a few safety rules:

• An adult puts it on. Never let your child apply it.
• Rinse it off over a sink with warm water, not in the shower or bath.
• Never leave your child alone with medicine in their hair, and never put a plastic bag on their head.
• Store it in a locked cabinet, out of sight and reach.

Babies and toddlers need a doctor's or pharmacist's go-ahead before any lotion. CDC says to consult a healthcare provider before treating young children, and Cleveland Clinic notes that some treatments shouldn't be used on babies. Mention asthma, eczema or broken skin on the scalp to the pharmacist before you buy.

Breastfeeding and found lice on yourself as well? The NHS Specialist Pharmacy Service prefers combing with ordinary conditioner, and suggests keeping your hair short or tied up so your baby doesn't suck on it during treatment. Pregnant mums should ask a doctor or pharmacist before using any product on themselves.

Skip the kitchen cupboard. No studies prove that mayonnaise, olive oil or essential oils work, the AAP says, and it warns never to use kerosene or medicines made for animals.

Who to treat, what to clean and what to ignore

Official advice differs on who to treat. The NHS says to treat anyone who has head lice. CDC adds anyone who shares a bed with a person who has them. KKH's page goes further and says all close contacts need to be treated to cut the chance of re-infection. If a sibling has no lice but shares a bed, ask your GP or pharmacist which way to go.

Cleaning can stay small. The chance of picking up a louse that fell onto a carpet or sofa is very small, CDC says, so vacuum where your child sat or lay and stop there. You don't need a hot wash either, per the NHS. Skip fumigant sprays and fogs, which CDC says aren't needed and can be toxic. KKH advises against sharing hats, combs, towels, school lockers and hooks, so give a helper or grandparent who does your child's hair a separate comb.

Some of what you'll hear about lice is wrong:

• Lice can't jump or fly. The AAP says they crawl from one head to the next.
• Clean hair gets lice too, since the NHS says they aren't caused by dirty hair.
• Your dog or cat isn't to blame, as CDC says animals do not get or spread head lice.
• A swimming pool is an unlikely place to catch them, according to CDC, though chlorine won't kill them.
• Lotions don't prevent lice, and the NHS warns that using them that way can irritate the scalp.

Head lice at preschool and school in Singapore

ECDA, which regulates preschools, sets a clear rule. A child with at least one live, crawling louse has an infestation, and the centre should tell you to get it treated. ECDA says your child can return once no young or adult lice are found on the hair, after the first lice treatment, the end of an MC or a doctor's note saying they're fit. The rule is about live lice and young lice. It doesn't mention nits.

We found no MOE page that sets a head lice rule for primary schools, so ask your child's school how it handles a case. For comparison, the AAP discourages no-nit policies and says a child should not miss or be excluded from school because of head lice. In the US, CDC tells schools there's no need to send a child with lice home early.

For the other bugs that keep children home from care, see why kids keep falling sick at childcare. Add a labelled comb and towel of their own to the infant care and preschool packing list. Colds, fevers and tummy bugs are in our guide to common childhood illnesses in Singapore.

When to see a doctor

The NHS says you can treat head lice without seeing a GP. See your GP or a polyclinic if:

• the scalp shows signs of infection, which Cleveland Clinic lists as fever, sores that are pus-filled or won't heal, pain or tenderness, and redness or swelling
• a lotion seems to have failed: CDC says to talk to a doctor before treating again if you find no dead lice 8 to 12 hours later, or the lice look as active as before
• your child can't stop scratching, since Cleveland Clinic says the doctor may have other ways to protect the scalp
• you think it's lice but can't confirm it, which Cleveland Clinic says a doctor or school nurse can help with
• you find lice in the eyebrows or eyelashes, where CDC says they can also live, as lice lotion shouldn't go near the eyes
• lice keep coming back after full rounds of treatment, as KKH treats head lice in its Paediatric Dermatology Service and your GP can say whether a referral makes sense

The AAP says head lice don't cause serious illness, so they aren't an emergency on their own. KKH Children's Emergency and NUH Children's Emergency are for a child who seems seriously unwell. Call 995 for an emergency such as trouble breathing, a seizure or a child who can't be woken. If a fever comes with infected sores, the fever checker helps you decide how soon to go, and the paediatrician map shows doctors near you.

Frequently asked questions

How do kids get head lice?

Mostly from head-to-head contact with someone who has them. That happens a lot when children play together at school or at home, CDC says. Sharing a comb or a towel is a less common route.

Can my child go to preschool with head lice?

ECDA's guidance says the centre should tell you to get treatment if your child has at least one live louse. Your child can go back once no live lice are found on the hair and they've had the first treatment, their MC has ended or a doctor has certified them fit. Ask your centre what it needs to see.

Do I need to remove every nit from my child's hair?

Not always. Nits may stay in the hair after treatment, but CDC says successful treatment kills the crawling lice. Empty nits also stay on the hair after the eggs hatch, the AAP notes. Keep to your combing schedule so you catch any new lice.

How long do head lice live off the head?

Not long. Adult lice die within two days if they fall off and can't feed, according to CDC, and nits usually die within a week away from the warmth close to the scalp. That's why washing what your child used in the last two days is enough.

Why is my child still itchy after treating head lice?

The AAP says itching from head lice can last for weeks, even after the lice are gone. CDC notes that some lice medicines cause itching or a mild burning feeling too. See your doctor if you find a live louse or the scratching won't settle.