Head lice are not a reason to keep a child home. The CDC’s head lice guidance says you do not need to send students with head lice infestation home early from school, and the American Academy of Pediatrics believes a child should not miss or be excluded from school because of head lice. The decision in front of you is not whether to pull your child out of class. It is how to confirm what you are looking at, treat it safely, and keep it from coming back.
What the CDC and the AAP Say About Lice and School Days
Both say the same thing: a child with head lice does not need to be sent home early or kept out of class. The CDC states that head lice do not transmit any disease and are therefore not considered a health hazard, and the AAP writes that head lice may be a nuisance but do not cause serious illness or carry any diseases.
The other half is how lice travel. The CDC says head lice mainly spread by direct contact with the hair of a person who has them, and that they move by crawling, because they cannot hop or fly. The AAP adds that there is a very small chance of spread from sharing items such as combs, brushes, hats and sports helmets. Getting head lice, the CDC says, is not related to cleanliness of you or your environment. Our fuller answer on kids staying home with lice takes the question further.
Is It Really Lice? What to Look For Before You Treat
A live louse settles it. The CDC calls finding a live nymph or adult louse on the scalp or hair the best way to diagnose head lice, and it warns that misdiagnosis of head lice infestation is common. The AAP explains why: live lice are hard to find, because they avoid light and move quickly. Seat your child in a brightly lit room, part the hair in very small sections down to the scalp, and work through it with a fine-tooth nit comb. The AAP says the easiest place to find them is at the hairline at the back of the neck or behind the ears.
| What you find | What the CDC and the AAP say | What it means |
|---|---|---|
| A live crawling louse or nymph | The best way to diagnose head lice (CDC) | An active infestation; ask your child’s doctor before treating (AAP) |
| Nits firmly attached within 1/4 inch of the scalp | Where to look when no crawling lice turn up (CDC) | Lice attach their eggs to hair close to the scalp (AAP), so keep looking |
| Only nits more than 1/4 inch from the scalp | Almost always hatched or dead (CDC) | Probably an old infestation that does not need treatment (CDC) |
| Specks that lift off the hair easily | Nits stay firmly attached; dandruff and dirt do not (AAP) | Use medicine only when it is certain the child has living head lice (AAP) |
If you are not sure, the CDC says to see your healthcare provider.
Can You Leave Head Lice Treatment on a Child Overnight?
No. Lice medicine stays on for the time its label gives, and not longer. The CDC says to use the lice medicine as directed on the box or label, and the AAP’s guidance for parents says to follow the directions on the package exactly as written. Those windows are not all long: the AAP notes that some prescription products have application times as short as 10 minutes, followed by a simple rinse with water.
Stretching a product past its instructions is improvising with an insecticide, which is the CDC’s word for these drugs; it says they can be dangerous if misused or overused, and that you should not use extra amounts of any lice medication unless your physician and pharmacist instruct it. The AAP’s household rules are just as plain. An adult applies the medicine, never a child, and do not leave a child alone with medicine in his or her hair. Never place a plastic bag, or anything made of plastic, on a child’s head. And check with your child’s doctor before beginning any head lice treatment.
What the Next Two to Three Weeks Look Like
Plan on two to three weeks, not one evening. The CDC’s treatment guidance says to check the hair and remove nits and lice every 2 to 3 days for the next 2 to 3 weeks after each treatment. The AAP says plainly that the comb-out method usually doesn’t work on its own to get rid of head lice. How often to comb after lice treatment walks through that schedule.
The CDC says nits may stay in hair after treatment, but successful treatment will kill crawling lice, and the AAP notes that itching caused by head lice can last for weeks, even after the lice are gone. Neither is proof that treatment failed.
The rest of the house matters too. Both the CDC and the AAP say all household members and close contacts should be checked, and treated if necessary, and the CDC adds that anyone infested and the people they share a bed with are treated at the same time. The AAP says the cycle can repeat every 3 weeks if head lice are left untreated. For the household side, see our post on lice treatment for the whole family.
Frequently Asked Questions
How long after lice treatment can my child go back to class?
The CDC’s position is that a child can go home at the end of the day, be treated, and return to class after beginning appropriate treatment. What takes time is the medicine: the CDC says it takes time to kill all the lice, and lice still moving slowly 8 to 12 hours later do not call for another application.
Should a child stay home if a classmate has lice?
No. A note about a classmate is a reason to check your child’s head, not to keep them home. The CDC’s prevention advice is about contact, not attendance: teach children to avoid head-to-head contact during play and other activities at home, school and elsewhere, and not to share combs, brushes, towels, hats, scarves, coats or hair ribbons.
When can I wash my child’s hair after treatment?
Not right away. The CDC says not to re-wash the hair for 1 to 2 days after removing the lice medicine, and the AAP puts the same window at 24 to 48 hours before shampooing. The CDC also says not to use a combination shampoo/conditioner, or conditioner, before using lice medicine, which it lists among the reasons treatment fails.
What if I still see live lice several days after treatment?
Call your child’s doctor before reaching for a second product. The CDC lists the reasons treatment fails: misdiagnosis, not following treatment instructions, head lice resisting the medication, and reinfestation after successful treatment. For a medicine that kills lice but not eggs, the CDC says to treat again about a week after the first treatment, 7 to 9 days depending on the drug, and the AAP says to check with your child’s doctor before beginning a second or third medicine.
Is a lice treatment clinic worth it instead of treating at home?
It is worth it when you cannot confirm what you are seeing, or when what you tried did not work. The AAP says parents sometimes treat their children with over-the-counter treatments up to 5 times before seeking help from their pediatrician, and that it is best to call your pediatrician before treatment. A clinic checks every head in the family in one visit.
How Lice Lifters of Mercer County Can Help
When you would rather not sort this out alone, that is what we do. At Lice Lifters of Mercer County, a visit starts by checking the whole family, not only the child who itches. Our professional lice treatment is non-toxic and safe for all ages, and it is done in one visit. Same-day appointments are available, so a head check does not have to wait for a day off. Our 30 Day Guarantee applies when the whole family is checked. If you are staring at a comb tonight and are not sure what you found, book a head check and let us look.
