Head lice: how do I check my child and get rid of them?

What head lice look like

An adult louse is 2–3 mm long and grey, brown, black or reddish. Young lice are smaller and harder to spot (1177). Lice live on blood and move by climbing from hair to hair. Away from the hair they quickly become weak and die (1177).

The eggs (nits) are about 1 mm long. Empty, hatched eggs are pale and yellowish-white, and they move outwards as the hair grows. Finding eggs does not mean that your child has live lice (1177). Black powder on the pillow or collar can be lice droppings (1177).

Adults with lice and children who were recently infected often have no symptoms, so they can pass lice on without knowing it (1177).

How to check with a lice comb

• Choose the right comb: CE-marked, light-coloured, with dense and stiff teeth. Ask at the pharmacy if you are unsure (1177).
• Use conditioner: lice keep still and are easier to find in hair with conditioner (1177, Läkemedelsverket).
• Comb over something white: for example a sheet or a mirror, and wipe the comb on white paper after each stroke (1177).
• Work in sections: start at the back of the head, make a parting and comb from the scalp along the whole hair. Then make a new parting right next to it (1177).
• Take your time: about 10 minutes for short hair and 20–30 minutes for long or curly hair (NHS). For thick or very curly hair, comb a small lock at a time (1177).

How to treat

Treat only if you find a live louse. The effect of treating to prevent lice is uncertain (1177), and the NHS advises against using lice lotions to prevent them.

• First choice: a medical device product with dimeticone, as a lotion, spray or shampoo (1177, Läkemedelsverket).
• Two treatments: the second one kills lice that hatch from eggs that survived. 1177 advises the second treatment after 9–10 days and Läkemedelsverket after 7 days, so follow the instructions on your product. Comb every day in between (1177).
• Everyone with live lice at the same time: treat everyone in the household who has live lice on the same occasion (Läkemedelsverket). Others in the family should comb too (Folkhälsomyndigheten).
• Keep combing afterwards: once a day for a week after the last treatment, then at least twice more the following week (1177).
• If dimeticone does not help: there is an over-the-counter medicine with benzyl benzoate and disulfiram. It stays in the hair for 24 hours, and two treatments are needed (1177).

Wet combing with conditioner alone is another option. The NHS describes combing on days 1, 5, 9 and 13 and checking again on day 17. The NHS also says that electric combs, repellents and oils such as tea tree, eucalyptus and lavender are unlikely to work.

School, friends and feelings

Your child does not need to stay home from preschool or school if you follow the treatment and comb every day. Avoid head-to-head contact until both treatments are done (1177).

Tell the people your child has been close to, such as the class or preschool group, so that everyone can check and be treated at the same time. That is how you stop lice going round and round (1177).

Lice are most common after the summer holidays, when children get together again. Combing everyone before school starts is the best way to stop lice spreading (1177, Läkemedelsverket).

If your child feels embarrassed, explain that anyone can get lice, that it has nothing to do with being clean and that it is not dangerous (1177).