Treatment

Head lice are only found on the human head or hair. Head lice do not live on furniture, hats, bedding, carpet or anywhere else in the environment. Treating anything other than the human head does not eradicate head lice.

There are two main treatment options to remove head lice:

• mechanical removal
• chemical removal.

On this page

1. Mechanical removal
2. Chemical removal
3. What to do with bedding and clothing
4. Choosing the right treatment for you or your child
5. More information about the comb and conditioner method
6. Some tips for treating long hair
7. Head lice in schools

Mechanical removal or 'comb and conditioner' method

What you need for this method

• Normal comb to detangle hair prior to using metal lice comb
• Fine toothed metal lice comb (available from your local chemist or online)
• Conditioner - buy a cheap brand as you will be needing a lot of it, and preferably one that is white to make spotting the lice easier
• White paper towel

Mechanical removal involves applying conditioner to dry hair. Cover all of the hair with conditioner, detangle hair with normal comb and separate into sections. Then, using a fine long toothed metal lice comb, comb through the hair in sections. The conditioner does not kill lice but stuns them for about 20 minutes enabling easier removal. The long toothed metal comb will remove nits and the stunned head lice. Wipe the comb on a white tissue and check for any lice or nits. Keep combing until no more appear on the tissue. This method should be done every second or third day until no nits and lice remain, usually about 7 to 10 days. Please see the explanation below for more detailed guidance.

This method is the preferred way to detect and treat head lice because it is effective, does not contribute to insecticide resistance in head lice and also presents a low risk of skin irritation.

This method also helps manage head lice before they become established on the head. Simply keep a good head lice comb in the shower and every time your family washes their hair use the fine comb through the hair. This will ensure lice are "caught" before they lay too many eggs. If your children are old enough to wash their own hair encourage them to use the comb themselves. Or keep a comb handy to where you wash your children's hair and use it every shampoo.

Chemical removal

What you need for this method

• Normal comb to detangle hair prior to using metal lice comb
• Chemical treatment containing synthetic or natural insecticides that kill head lice (talk to your local pharmacist to identify the treatments containing insecticides)
• Fine toothed metal lice comb (available from your local chemist or online)
• White paper towel

If you choose to use a chemical treatment, remember to follow the instructions carefully. You will also need to comb through the hair to ensure the treatment is working. If you find dead lice it means the product has worked. If you find live lice, the treatment has not worked. Don't be tempted to re-apply or over-apply the same chemical if it doesn't appear to be working. Instead switch to another treatment that uses a different chemical compound or use the ‘comb and conditioner method’ as described under the mechanical removal. It is very important that you repeat the chemical treatment in seven days to kill any newly hatched eggs as most chemical treatments will not kill the eggs (nits).

Once your child is free of lice and nits, remember to regularly check with a fine toothed head lice comb and conditioner as described above. Early detection and treatment will prevent re-infestation of other family members and classmates.

What to do with bedding and clothing

Research suggests that bed linen, hats, clothing and furniture do not harbour or transmit lice or nits and that there is no benefit in washing them as a treatment option. Nits and lice only live on the human head. They quickly dehydrate and die if removed from the head.

Choosing the right treatment for you or your child

Before you choose a treatment for head lice, consider:

• Mechanical removal is the preferred way to detect and treat head lice because it is effective, does not contribute to insecticide resistance in head lice and also presents a low risk of skin irritation.
• If you prefer to use chemical treatment, make sure that the heads you treat are infested with head lice.
• Registered chemical treatments that contain insecticides to kill lice are usually safe, but excessive use of other substances, such as home remedies and other insecticides, can cause irritation. Speak to your local pharmacist to identify the registered treatments that are safe for you and your child.
• Always read the product label before applying and use as directed.
• Natural products like tea tree oil are not recommended. If you don’t want to use chemical treatment, use the mechanical removal described above.
• Do not use methylated spirits or kerosene on your child’s head.
• Avoid treating babies with chemical treatment.
• Avoid chemical treatment on any scalp that is irritated or inflamed.
• Protect children’s eyes when treating with any product.
• There is no preventative treatment available for head lice. Treating the whole family with chemical treatment as a precaution contributes to head lice becoming resistant to the products used.

Remember that you can help to reduce transmission of head lice by tying hair back or braiding and by checking your children’s hair regularly.

More information about the ‘comb and conditioner method’

Mechanical removal of nits and lice can be a time-consuming task depending on the severity of the infestation and the amount and length of a child’s hair. Some ideas to help with this include:

1. Try sitting the child between your legs on a low stool and play a video for kid’s entertainment while you work. If the child has long and thick hair this may take up to an hour (see tips for treating long hair below)
2. Wrap a towel or kitchen paper around the child's shoulders to catch conditioner spill.
3. Remove any hair clips, ribbons or clasps from the child's head and comb out plaits and braids.
4. Apply liberal amounts of conditioner to the scalp and massage it through all the hair shafts. Every hair has to be coated to ensure it reaches the lice.
5. Lice live close to the scalp, so make sure that you cover the hair shaft close to the scalp. You don't have to work the conditioner onto the whole length of the hair. Combing will spread it well enough. The idea of the application is to restrict the movement of the head lice long enough for you to catch them with a comb.
    
6. After you've applied the conditioner, use a large comb to part small sections of the hair starting from the nape and working upwards toward the crown. Eggs are often found behind the ears and toward the back of the head. By using this method, you are more likely to find the head lice on top of and toward the front of the head.
7. When the hair is detangled and manageable, use a fine lice comb to comb out each section several times.
8. After each comb out, wipe the conditioner on the paper towel. If the child has head lice, you will see them on the towel.
    
9. Keep combing each section of hair until no further lice, nymphs or eggs appear on the paper towel. You may see lots of old egg casings that may take a while to remove.
10. Once you have combed and recombed each section of hair, wash out the conditioner.
11. Simply clean the comb with hot soapy water and rinse off with hot water.
12. If your child has long hair, re-plait or tie it back. Kids with short hair may like their hair spiked.
13. It is very important to retreat the hair after seven days to ensure that any immature head lice that have hatched since the initial treatment are removed before they can lay more eggs.

Some tips for treating long hair

Depending on the hair length and type, it is often easier to neatly section long and thick hair before applying conditioner to avoid getting the hair into a terrible tangle. Some ideas on how to do this are described here:

1. Part long hair once from forehead to scalp, and use hair clips to keep the part in place.
2. Apply conditioner along the part line. This is to stop lice from crossing from one side of the head to the other.
3. Part the hair in a straight line from the ear around the scalp to the centre part and clip or pin the top section to the crown of the scalp. Do this also on the other side until you have four sections. You can part the hair into more sections if needed.
4. Apply conditioner to all the parts and massage in.
5. Work through the sections one by one, starting from the nape. Apply conditioner to each section and comb out several times as described above.

Head lice in schools

Head lice infestation is a common problem throughout the world in all socioeconomic groups. Considerable myth and misinformation surrounds head lice and their management. Studies have shown that around one in four primary school aged children in Australia have head lice.

NSW Health does not recommend excluding children with head lice from school due to the following reasons:

• Head lice are not known to transmit diseases.
• Exclusion from school or childcare is not an effective way of breaking the cycle of head lice infestations.
• Head lice eradication is most effective if the whole school community works together to treat the infestation, for example running the Nitbuster program.

For further information on how to best tackle head lice in schools, please see Nitbusters.