Head lice: finding them, the wet-comb and lotion routines, and the myths
Last updated September 3, 2026.
Head lice are a normal part of childhood, they have nothing to do with dirty hair, and you can clear them without drama once you know the routine. They spread by head-to-head contact, which is why they love schools. The only reliable way to know you are dealing with lice is to find a live, moving louse: specks alone are usually dandruff, and empty eggshells can linger months after lice are gone.
How do you check properly?
Wet combing is the gold-standard check: wash the hair, coat it in ordinary conditioner, and comb section by section from root to tip with a fine nit comb, wiping the comb on white kitchen paper each pass. Live lice are sesame-seed sized, grey-brown, and move fast; you are looking for movement. Eggs (nits) are the size of a pinhead, firmly glued to the hair shaft near the scalp, and do not flick off like dandruff. Check the whole household at the same time; treating one child while a sibling hosts the colony is how families get stuck in loops.
What actually helps?
- Wet combing as treatment: done thoroughly every 3 to 4 days for two weeks (sessions on days 1, 5, 9, and 13 are the classic schedule), wet combing alone clears infestations if you are meticulous. The conditioner immobilizes the lice so they wipe off onto the paper.
- Lotions and sprays for a faster kill: dimethicone-based products coat and suffocate lice physically, so resistance is not an issue, and they are the usual first choice. Apply exactly as directed on dry hair, leave for the stated time, and repeat on day 9 to catch any lice that hatch from surviving eggs, because no product reliably kills unhatched eggs.
- Treat the household the same day: everyone with live lice gets treated on the same day, and everyone else gets comb-checked. Notify the school or nursery and close contacts so the circle gets treated, without blame; lice prefer clean hair if anything.
- Sensible housekeeping, not fumigation: lice die within a day or two off the head and cannot jump or fly, so the house is not the battleground. Hot-wash the pillowcases and bedding used in the last couple of days and soak combs and brushes in hot water; spraying the sofa and bagging toys for weeks is wasted effort.
- School rules: there is no medical need to keep a child off school for lice; treat tonight, comb, and send them in. Tying long hair back reduces head-to-head spread.
When is it an emergency?
Never an emergency, but see a pharmacist or doctor if diligent treatment keeps failing (you may be seeing reinfestation, a misidentification, or a resistance issue worth switching products for), if the scalp becomes very sore, crusted, or oozing (scratched bites can infect), or if you find lice on eyelashes, which needs specific advice. Persistent scalp itching with no lice found on repeated wet-combing deserves a look for other causes like eczema or an allergy. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
How do kids actually get head lice?
By head-to-head contact: playing, hugging, leaning over the same tablet, selfies. Lice cannot jump, fly, or swim; they crawl, so heads need to touch for about a minute. Sharing brushes, hats, and headphones is a minor route compared with direct contact. They are most common in children aged roughly 4 to 11 and in the people who cuddle them. Catching lice is a marker of a sociable child, nothing more.
Do head lice mean dirty hair or a dirty home?
No, and the stigma is the worst part of them. Lice are equally happy on clean and dirty hair; some evidence suggests clean hair is easier for them to grip. They feed on tiny amounts of blood from the scalp, not dirt, and a spotless house gets them as readily as any other. Washing bedding and combs during treatment is sensible; deep-cleaning the house is not, because lice die within a day or two away from a head.
What is the most effective way to get rid of head lice?
Two proven routes. Wet combing: conditioner on wet hair, fine nit comb section by section root to tip, wiping on white paper, repeated on days 1, 5, 9, and 13 to break the life cycle. Or a dimethicone lotion on dry hair, left on as directed, with a mandatory second application on day 9 to kill hatchlings from surviving eggs. Both fail for the same reason: skipping the repeat. Check with the comb a few days after the final session to confirm no live lice remain.
What are nits, and how are they different from dandruff?
Nits are the eggs and empty shells lice glue to hair shafts. Live eggs sit within about half a centimeter of the scalp and are brownish; empty shells are white and sit further out as hair grows. The test is simple: dandruff and lint slide or blow off, while nits are cemented to the hair and need to be slid off with the comb or fingernails. Finding only empty shells, with no live lice on thorough wet combing, means an old, already-resolved infestation.
Do I need to treat the whole family and fumigate the house?
Check everyone with a wet comb, and treat everyone with live lice on the same day so nobody re-seeds anyone else. Household members without lice do not need treatment, just weekly comb checks for a couple of weeks. Skip the fumigation: lice die within 24 to 48 hours off the scalp, so hot-washing the pillowcases and bedding used in the last couple of days and soaking brushes and combs in hot water for 10 minutes is all the housework that is needed.
Does my child need to stay off school with head lice?
No. Current guidance is that head lice do not require school exclusion: treat in the evening, comb, and send them in the next day. Tying long hair back and braiding it reduces head-to-head transfer at school. Tell the school or nursery and your child's close-contact families so they can check and treat at the same time; quiet coordination clears a class far faster than any exclusion policy.
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