Head Lice
Tiny insects that live on the scalp and spread by head-to-head contact. Super common in primary school kids, harmless, and nothing to do with clean or dirty hair. Annoying, yes. Dangerous, no.
The head lice ladder
Combing is the backbone of every step. Any lotion needs a second go 7 days later, because eggs hatch.
- Step 1 · Self-careConditioner and combCover dry hair in white conditioner, then comb section by section with a fine metal nit comb. Wipe the comb on a tissue.
- Works
- On its own, clears about 4–6 in 10 kids in trials; it also shows if a treatment is working
- Cost
- About $10–20 for a good metal nit comb, plus cheap conditioner
- How long
- Every 1–2 days until no live lice for 10 days
- Watch for
- Tears and boredom. A show on the tablet helps.
The world’s most effective lice treatment is a parent with a comb and patience.
- Step 2 · PharmacyDimeticone lotion or spraySilicone-based, not an insecticide: coats lice so they can’t survive.
- Works
- Cleared about 7 in 10 in a UK trial, as well as an insecticide; works on resistant lice too
- Cost
- About $20–35 a bottle
- How long
- Apply, leave as directed, wash out. Repeat after 7 days.
- Watch for
- Flammable while on hair: keep away from heaters, flames and hair dryers. Check the age on the label.
Lice can’t become resistant to being smothered.
- Step 3 · PharmacyInsecticide lotion (permethrin, pyrethrins or malathion)Kills lice chemically.
- Works
- Variable: cleared only about 1 in 8 in a UK trial; many Australian lice are now resistant to some products
- Cost
- About $15–30 a bottle
- How long
- Apply as directed. Repeat after 7 days.
- Watch for
- Scalp itch or irritation. If it fails, switch to a different type rather than repeating the same one.
Dousing harder with the product that didn’t work is just expensive hair conditioning.
- Step 4 · PrescriptionGP visit (sometimes ivermectin tablets)When lice won’t budge: check the diagnosis, treat any infected scratched scalp, and consider tablets.
- Works
- Ivermectin cleared about 95% in a large trial (vs 85% with malathion lotion)
- Cost
- GP visit (often bulk-billed for kids) plus a private script
- How long
- 2 doses, a week apart
- Watch for
- Not for children under 15 kg or in pregnancy. Mild nausea.
Rarely needed. Most “treatment failures” are a missed second dose or a re-infestation from a friend.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Tea tree oil and repellent spraysNo good evidence they prevent lice. Tying hair back and weekly comb checks are more useful.
- Mayonnaise, olive oil or vinegarNo good evidence they reliably kill lice or eggs. Messy salad, happy lice.
- Kerosene, petrol or pet flea treatmentsDangerous: they can burn skin, catch fire or poison. Never on anyone’s head.
- Fumigating the house, car or dogLice die quickly off the head and don’t live on pets. Wash the pillowcases and put the bug bomb down.
What you can do
- Check everyone in the house with conditioner and comb. Treat only those with live lice.
- Always do the second treatment 7 days later.
- Tie long hair back for school.
- Wash pillowcases hot or pop them in the dryer.
- Tell the school and close friends’ parents. It’s routine, not a scandal.
See your GP or pharmacist if
- Lice keep coming back despite two different treatments done properly
- The scalp is weepy, crusted or very sore, or neck glands are swollen
- Your child is under 6 months, or you’re pregnant or breastfeeding and need treatment
Lice don’t jump, fly or live on pets. Most Australian guidance says children don’t need to miss school once treatment has started.
Common questions
How do I know if it’s head lice?
You see live lice when combing with conditioner. Eggs (nits) stuck close to the scalp suggest a current problem; empty shells further down the hair may be old.
Do I need to clean the whole house?
No. Lice die quickly off the head. Wash pillowcases and hats hot or put them in the dryer; that’s enough.
Why didn’t the lice treatment work?
Usually the second treatment was missed, lice were resistant to that insecticide, or your child caught them again. Keep combing and switch to a different type of product.
Do tea tree oil or repellent sprays prevent head lice?
There’s no good evidence they work. Tying hair back and regular comb checks are more useful.
Helpful resources
- Better Health Channel: Head liceStep-by-step conditioner and comb method for weekly checks and treatment. Free, printable.
- NSW Health: Head lice FAQsMyth-busting answers on how lice spread (and don’t). Handy for anxious parents and schools. Free.
Evidence and more information
- Healthdirect: Head lice and nits in children
- Perth Children’s Hospital: Head lice guideline
- BMJ (2005): Bug Busting combing vs insecticides
- BMJ (2005): Dimeticone vs phenothrin trial
- NEJM (2010): Oral ivermectin vs malathion for head lice
maladywise.com/head-lice/