Head lice: signs, safe treatment and which doctor to see
How to tell if your child has head lice, how they spread, treatments that work, what not to put on a child's head, and when to see a doctor.
Also known as: Pediculosis
What head lice are
Head lice (known in many Indian homes as joon or pen) are tiny wingless insects, about the size of a sesame seed, that live in the hair close to the scalp and feed on small amounts of blood. The females lay eggs that they glue firmly to the hair shaft near the scalp. The eggs, and the empty shells left after they hatch, are called nits.
Head lice are very common in school-age children, especially girls with long hair, and they easily pass to mothers, siblings and grandparents. They are a nuisance rather than a danger: head lice do not spread disease. Having lice is not a sign of being dirty or of poor care — lice are just as happy in clean hair as in unwashed hair.
Signs and symptoms
- An itchy scalp, especially behind the ears and at the back of the neck. The itch is an allergic reaction to the bites and may take weeks to develop after a first infestation, so some children have no itch at all
- A tickling feeling of something moving in the hair
- Nits — tiny white, yellow or brown specks stuck to hairs close to the scalp, which do not brush or blow off the way dandruff does
- Live lice — small, greyish-brown insects that move quickly away from light
- Sores on the scalp from scratching, which can become infected
- Disturbed sleep and irritability, as lice are more active in the dark
Dandruff, dry skin, hair-spray residue and scalp conditions such as seborrhoeic dermatitis can look like nits. The key difference is that nits are stuck to the hair and are hard to slide off.
How they spread
Lice cannot jump or fly. They crawl from one head to another during close head-to-head contact — children playing, hugging, sharing a bed, sitting close over a phone or taking selfies together. Less often, they may pass on combs, hairbrushes, hair ties, scarves, caps, helmets or pillows used soon after by someone else. Pets do not carry human head lice.
A louse that falls off the head dies within a day or two, so homes do not need to be fumigated, and children do not need to be kept away from school once treatment has started.
How it is diagnosed
The only sure sign of an active infestation is finding a live louse. Nits on their own may be old empty shells from a past infestation, especially if they are more than a finger-width from the scalp. The most reliable way to check is detection combing:
- Wash the hair and apply plenty of ordinary conditioner, which slows the lice down
- Comb out tangles with a normal comb
- Use a fine-toothed lice comb (a metal one works well), placing the teeth at the scalp and drawing it to the ends of the hair
- Work through the whole head section by section, wiping the comb on a white tissue after each stroke to look for lice
- Rinse out the conditioner and repeat the combing
If you find a live louse, check everyone in the household the same way, and treat only those who have live lice. A doctor can also confirm the diagnosis by looking closely at the scalp.
Treatment
There are two main approaches, and they work best when done carefully and repeated. A doctor or pharmacist can help you choose:
- Lice lotion — medicated lotions, creams or sprays applied to dry or damp hair for a set time, as the label says. Some contain insecticides such as permethrin; others, such as dimeticone, coat the lice and stop them working. Lice in some areas have become resistant to certain insecticides, so if one product fails, ask about a different type rather than repeating the same one again and again.
- Wet combing — combing through wet, conditioned hair with a lice comb, as described above, every three or four days for at least two weeks until no live lice are found on three checks in a row. This takes time but uses no chemicals and is a good option for babies, pregnant women and people who prefer not to use lotions.
Most lotions do not kill every egg, so a repeat treatment about a week after the first is usually needed to catch lice that hatch afterwards. Follow the instructions on the pack exactly, and check with a doctor before using any product on a baby, during pregnancy or breastfeeding, or on a child with asthma or a scalp condition. Removing nits with fingernails or a comb is optional; it helps you see whether new eggs are appearing.
Home remedies such as oils, vinegar or herbal pastes have not been shown to work reliably, and they can delay effective treatment. Some can irritate the scalp or eyes.
Preventing it from coming back
- Check your child's hair once a week with a lice comb during school terms, so a new infestation is caught early
- Tie long hair back in a plait or bun for school
- Teach children not to share combs, hair ties, caps or helmets
- Wash pillow covers, towels and hair accessories used in the two days before treatment in hot water, or seal them in a bag for a couple of days; soak combs and brushes in hot water
- Tell the school and the parents of close friends, so other children are checked at the same time — otherwise lice tend to pass back and forth
Anti-lice shampoos used as a preventive, without an infestation, are not recommended. They do not prevent lice and may help resistance develop.
When to see a doctor
Most head lice can be handled at home with advice from a pharmacist. See a doctor if:
- You have treated correctly twice and still find live lice
- The scalp has crusted, weeping or painful sores, or swollen glands in the neck — signs of a skin infection such as impetigo
- The person is a baby, is pregnant or breastfeeding, or has a skin condition such as eczema
- A treatment caused redness, burning or a rash
- You are not sure whether it is lice, dandruff or another scalp condition
- Itching persists in other parts of the body, which could suggest scabies rather than head lice
Call 112 or 108 straight away if a child has swallowed a lice product, kerosene or any insecticide, has had a chemical splashed in the eyes, or develops swelling of the face, wheezing or difficulty breathing after a product is used.
Which doctor to see
For children, a paediatrician or general physician can confirm head lice and recommend a suitable treatment. A dermatologist is helpful when treatment keeps failing, when the scalp is infected or inflamed, or when it is unclear whether the problem is lice or another scalp condition.
You can find dermatologists in Bengaluru or paediatricians in Bengaluru on The Doctor Index, each with a registration you can check.
Common questions
Questions people ask
- Do head lice mean my child is not clean?
- No. Head lice spread by head-to-head contact, not dirt. They are just as common in clean, well-kept hair as in unwashed hair. Any child who plays closely with other children can get them, so there is no reason to feel ashamed.
- Should my child stay home from school with head lice?
- Usually not. Most doctors advise that a child can continue going to school once treatment has started. By the time lice are found, they have often been there for weeks. Telling the school helps classmates get checked and stops lice passing back and forth.
- Why do head lice keep coming back?
- The commonest reasons are not repeating treatment a week later, not combing thoroughly, lice resistant to the product used, and being re-infested by a friend or family member who was not checked. Check everyone at home and tell close contacts at the same time.
- Can adults get head lice?
- Yes. Adults, especially mothers, grandparents and teachers who are in close contact with children, often pick them up. The signs and treatment are the same. Check yourself and other household members whenever a child is found to have lice.
This condition is usually assessed by a dermatologist. Every profile shows the doctor’s registration and what has been checked.
Dermatologists in Bangalore
A few dermatologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Head Lice; ask the clinic whether the doctor sees it.
Related conditions
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Head Lice
- Emergency Response Support System, Government of India — 112
- MedlinePlus, National Library of Medicine — Head Lice — Public-domain health-topic summary
Head lice: signs, safe treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1084.