Combing is the natural part of getting rid of lice, but on its own it usually is not enough. The American Academy of Pediatrics is blunt about the limits of combing alone: “the comb-out method usually doesn’t work on its own to get rid of head lice,” and it calls head lice medicine “the most effective way to treat head lice.” A professional nitpicker’s value is in the finding and the removing. Check everyone in the house, and ask your child’s doctor before any treatment.
What Actually Gets Rid of Head Lice
Everyone with live lice needs treating at the same time, because the CDC says head lice mainly spread by direct contact with the hair of a person who has them. The CDC’s treatment guidance says to treat all infested household members and close contacts together, and to check every household member. Its guidance also says to use the medicine as directed on the box or label, and the AAP says to use it only when the child certainly has living head lice.
Combing stays part of the plan. The CDC says to use nit combs to remove nits and lice from the hair shaft and, after each treatment, to check the hair and remove nits and lice every 2 to 3 days for the next 2 to 3 weeks.
The CDC lists these reasons treatment fails:
- Misdiagnosis
- Recent application of a combination shampoo or conditioner to the hair
- Not following treatment instructions
- Head lice resisting the medication
- Reinfestation after successful treatment
If crawling lice are still present after a full course of treatment and retreatment, the CDC says to consider an alternative medication, and the AAP says to check with your child’s doctor before beginning a second or third medicine. If you are weighing outside help, our post asks when to see a lice professional.
Why Oil and Mayonnaise Are Not the Answer
Smothering lice with kitchen oils has no proof behind it. The CDC says it “does not have scientific evidence that suffocating head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment.” The AAP says the same of petroleum jelly, mayonnaise, tub margarine, essential oils and olive oil: no studies prove they work.
Two steps come with a warning. The AAP says never to place a plastic bag on a child’s head, and that anything made of plastic there is dangerous, so an overnight shower cap is out. For malathion lotion, the CDC says not to smoke or use electrical heat sources, including hair dryers, curlers, and curling or flat irons, when applying it and while the hair is wet, and that malathion is flammable.
The AAP says head lice can be resistant to the active ingredients in over-the-counter treatments in some communities and that the likelihood varies across the country, while the CDC says the prevalence of resistance is unknown. The CDC also calls these drugs insecticides that can be dangerous if misused or overused. Our post on natural lice treatment, what works and what’s dangerous, looks at the home remedies in more detail.
How To Check for Lice Yourself, Section by Section
A home check works when you slow down and use good light. The AAP says to seat your child in a brightly lit room, part the hair, and look for crawling lice and nits a section at a time. Its comb-out steps are to wet the hair, comb small sections with a fine-tooth nit comb, wipe the comb on a wet paper towel, and examine the scalp, comb and towel before moving on.
Start at the hairline at the back of the neck and behind the ears, which the AAP calls the easiest places to find them. The CDC puts adult lice at roughly 2 to 3 mm, about the size of a sesame seed, and nymphs at about the size of a pinhead.
The hard part is telling a nit from everything else, and the CDC says misdiagnosis of head lice infestation is common.
| What you find | What the CDC and the AAP say it means |
|---|---|
| A live nymph or adult louse on the scalp or hair | The best way to diagnose a head lice infestation |
| A speck that is not firmly attached to the hair | Nits are held in place by a sticky substance; dandruff, dirt and hair spray droplets are not firmly attached |
| Nits within 1/4 inch of the base of the hair shaft | What to look for when you see no crawling lice |
| Only nits more than 1/4 inch from the scalp | The infestation is probably old and does not need treatment |
When you cannot tell, the CDC says to see your healthcare provider, and our post on how professional lice screening works shows what a trained check adds.
What a Professional Nitpicker Does, and What To Ask Before You Book
A nitpicker’s work is systematic coverage of one head, section by section. Nits sit close to the scalp, held fast by a sticky substance, and some blend with a child’s hair color, which is why a quick glance can miss them.
Before you book anywhere, ask what the solution contains and who applies it, whether everyone in the household is checked at the same appointment, and what the plan is for the weeks that follow. Our own in-clinic treatment uses an enzyme-based solution that is non-toxic. The AAP’s position holds either way: call your child’s doctor before treatment, and ask again if what you have tried has not worked.
Frequently Asked Questions
Can you suggest trusted clinics for natural, chemical-free lice treatment?
We can speak for our own clinic. What we can tell you about Lice Lifters of Mercer County is concrete: an enzyme-based, non-toxic treatment, one visit, and a check for everyone in the family. Whether a medicine suits your child is a question for the child’s doctor.
How can I check for lice without a special comb?
A comb helps, and it need not be a specialty one. The CDC says a fine-toothed louse comb may help you find lice, and that flea combs made for cats and dogs are also effective. The AAP describes a lice egg as yellow to white and about the size of a knot in thread.
How long does it take to get rid of lice?
Think in weeks, not in one evening. The CDC says it takes time to kill all the lice. The AAP says eggs hatch in 7 to 12 days, that nymphs become adults about 9 to 12 days after hatching, and that a second treatment, if live lice are seen, is recommended between days 7 and 10 depending on the medicine.
Why is my child still itching after the lice are gone?
Itching can outlast the lice. The AAP says itching caused by head lice can last for weeks, even after the lice are gone, and that it may take 4 to 6 weeks after lice get on the scalp before the scalp becomes sensitive to lice saliva. The CDC calls the itch an allergic reaction to louse bites.
Do I need to clean the whole house?
No. The CDC says spending much time and money on housecleaning activities is not necessary to avoid reinfestation. It says to machine wash and dry what the person used in the two days before treatment, using hot water at 130 degrees Fahrenheit and high heat drying, and to seal what you cannot wash in a plastic bag for two weeks.
How Lice Lifters of Mercer County Can Help
At Lice Lifters of Mercer County, a visit starts with a head check for everyone in the family, because lice travel between heads and a single treated child in an unchecked house is a short-term fix. What we find decides what happens next. Our in-clinic professional lice treatment is non-toxic and done in one visit by certified technicians, and same-day appointments are available when a check cannot wait. Our 30 Day Guarantee applies when the whole family is checked. If you have been combing for days and are still finding live lice, book a head check and let us do the slow part.
