5 Steps to Combing for Head Lice


Chris Iliades, MD

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Even saying the words "head lice" can make parents squirm. However, these tiny, blood-sucking parasites have nothing to do with being dirty or being a bad parent. To be at risk, a child merely has to come in contact with another child who has head lice. That’s the most common way to catch head lice, even if your child has the cleanest head in the room.

Each year, head lice get into the hair of six to 12 million kids, ages 3 to 11. Kids can pick them up at school, camp, day care, or even at home, if someone brings them into the house. The insects are each about the size of a sesame seed. They lay eggs, called nits, which they glue to hairs, close to the scalp. Head lice can’t jump or fly, but they are fast crawlers.

Combing for Head Lice

Head lice are not dangerous, but they can make the scalp itch—and excessive scratching can lead to a scalp infection. There are many effective treatments available for head lice, including over-the-counter (OTC) and prescription shampoos, creams, and lotions. But combing for head lice is also an important part of controlling head lice. There are three reasons you should know how to do a head lice comb-through correctly:

  • To discover if head lice are present

  • To treat head lice

  • To check for head lice after treatment

Combing for head lice is a completely drug-free and safe way to treat head lice. People have used this method for thousands of years. Nit combs, which are very fine-toothed combs, have been found in ancient Egyptian tombs. You can get a modern version at your local pharmacy. Even if you opt to use an OTC or prescription lice product, you still need to comb well to remove the dead lice and nits after treatment.

5 Steps to a Good Head Lice Comb-Through

Before starting, you will need a nit comb, hair clips (for long hair), a large towel, facial tissues, a bowl of soapy water (use a squirt of dish soap), some hair conditioner, bright lighting, and possibly a magnifying glass. It may also help to have something to keep your child occupied, such as a favorite show or book. 

1. Wrap the towel around your child’s shoulders. Wet the hair with water and a little conditioner. This makes it easier to see lice and nits. Lice look like light brown sesame seeds that move. Nits are clear, yellow, brown or tan specks attached to the hair shaft near the scalp. You can tell the difference between nits and other debris because it’s easy to remove dandruff or other debris in the scalp. Nits stick to the hair.

2. Under a bright light at eye level, start the comb-through in sections. Pay attention to favorite lice spots—behind the ears and at the nape of the neck. Hold a section of hair with one hand and insert the nit comb as close to the scalp as possible. Comb through several times, checking for lice or nits. Use a magnifying glass if it helps. Dip the comb in soapy water and use the facial tissue to remove any debris.

3. After finishing each section of hair, pin it with a hair clip.

4. Clean up by flushing the liquid and tissue down the toilet. Clean the nit comb by soaking it in a solution of 2 cups of hot water and 1 teaspoon of ammonia. You can clean a metal nit comb in boiling water for 15 minutes.

5. After the cleanup is done, shampoo the hair thoroughly and let it dry. Then do a final dry check. If any nits are still attached to any hairs, carefully clip these hairs off with small scissors at scalp level.

If you use an OTC product, be sure to follow the directions carefully. Some products require retreatment within a specific time period. Also, be aware that some products are not suitable for children younger than age 2. After treatment, keep checking for lice and nits for about two weeks. See a doctor if two home treatments have not worked.

Wash items that may have come into contact with lice—hats, clothing, and bedding—in hot water, and dry them at high heat to sanitize them. Seal nonwashable items in plastic bags for two weeks. This will be long enough to kill adult lice and any newly hatched lice.

It's a good idea to keep checking all family members for up to two weeks. Lice live for only a day or two off the scalp, so a good vacuuming of the house should be sufficient. You don’t need to bomb your house with any pesticides. Tell your kids to avoid head-to-head contact with other children and not to share items, such as hats or headphones.

Key Takeaways

  • Head lice are not a sign of dirty hair or bad parenting.

  • Up to 12 million kids get head lice every year from close contact with other kids.

  • Combing is an important part of lice control and can be an effective treatment for lice.

  • Continue checking all family members for two weeks to be sure the lice are gone.

  • If combing and OTC treatments have not controlled lice in two weeks, see your family doctor for help.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jul 30, 2017

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Medical References

  1. Head lice: Diagnosis, treatment, and outcome. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/head-lice/diagnosis-treatment
  2. Managing Head Lice Safely - No Nit Policies. University of Nebraska-Lincoln http://lancaster.unl.edu/pest/lice/headlice018.shtml
  3. Treating Head Lice. U.S. Food and Drug Administration.   http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm171730.htm

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