Head Lice in Kids: How to Check, What Actually Kills Them, and Georgia School Rules

Last updated: September 2026

Head lice in kids are common, harmless to health, and treatable at home in most cases: check the scalp with a fine-tooth comb, use an FDA-approved product (not mayonnaise or essential oils), comb again every few days for two weeks, and send your child back to school. The CDC estimates 6 to 12 million infestations a year among US children ages 3 to 11, so if your child came home scratching, you have plenty of company.

Key takeaways

• Lice crawl from head to head. They do not jump, fly, or come from pets.
• Look behind the ears and at the nape. Nits glued within a quarter inch of the scalp mean an active case; nits farther out are usually empty casings.
• Permethrin 1% and pyrethrins are the over-the-counter starting point, but resistance is real. Prescription lotions like ivermectin and spinosad work in one application.
• The AAP and the National Association of School Nurses say children with lice should not miss school. Georgia districts set their own rules, so check yours.

How common are head lice in kids and how do they spread?

Very common. The CDC estimates that “6 to 12 million infestations occur each year in the United States among children 3 to 11 years of age.” Preschool and elementary school are the peak years. [Source: CDC, About Head Lice]

Lice spread almost entirely by direct head-to-head contact. According to the CDC, lice “move by crawling; they cannot hop or fly,” and “dogs, cats, and other pets do not carry or spread human lice.” Sharing hats, brushes, or pillows can pass them along, but sleepovers and wrestling on the couch are the usual route.

How do I check my child for head lice?

Use light, water, and a comb, not just your eyes. The AAP recommends seating your child in a brightly lit room and using a fine-tooth louse comb to search the scalp section by section. Wet hair slows the lice down and makes them easier to spot. [Source: AAP HealthyChildren.org, Signs of Lice]

Start behind the ears and at the nape. Part the hair in one-inch sections, comb from scalp to ends, and wipe the comb on a white paper towel after each pass.

You are looking for live lice (grayish-tan, sesame-seed sized, fast) and nits (tiny oval eggs, yellow-white to tan, glued to a single hair). Nits within a quarter inch of the scalp are likely viable. The CDC notes that nits more than a quarter inch from the scalp are almost always dead or already hatched. [Source: CDC, About Head Lice]

Is it lice, dandruff, or dry scalp?

The best test is the pull test: pinch the speck between two fingernails and slide it along the hair. Dandruff comes right off. A nit hangs on. Flaking with no attached nits and no bugs usually points to a common skin condition such as eczema or seborrheic dermatitis instead.

What actually kills head lice?

Over-the-counter options

Permethrin 1% lotion (Nix and generics) is approved for children 2 months and older. It kills live lice but not eggs, so a second treatment on day 9 or 10 is needed to catch the new hatch. The CDC notes that some resistance has been documented. Pyrethrins with piperonyl butoxide (Rid, A-200 and others) are approved for ages 2 and up, also need a day 9 or 10 repeat, and should be avoided in children allergic to chrysanthemums or ragweed. [Source: CDC, Clinical Care of Head Lice]

If you use an OTC product exactly as directed, twice, and still see live lice a few days after the second round, stop buying the same box. The CDC advises against treating “more than 2 to 3 times with the same medication if it isn’t successful.” That is the point to call your pediatrician.

Prescription options

• Ivermectin 0.5% lotion (Sklice): ages 6 months and up, one 10-minute application, no nit combing required.
• Spinosad 0.9% (Natroba): ages 6 months and up, kills lice and eggs, and “retreatment is usually not needed.”
• Malathion 0.5% (Ovide): ages 6 and up. Effective, but flammable and left on for hours, so rarely our first pick.
• Abametapir (Xeglyze): FDA approved in July 2020 for patients 6 months and older, “applied once to dry hair.”

[Source: CDC, Clinical Care of Head Lice] [Source: FDA, Drug Trial Snapshot: Xeglyze]

Coverage varies between these, so check our insurance resources page before heading to the pharmacy.

Wet combing

Wet combing is medication-free. Saturate the hair with conditioner, comb through with a metal nit comb section by section, and rinse the comb between passes. Repeat every 3 to 4 days for 2 weeks so you catch each new hatch before those lice mature and lay eggs. For babies under 2 months, or families who want to avoid chemicals, it is the method we usually recommend.

What does not work on head lice?

• Mayonnaise, olive oil, margarine, petroleum jelly. The CDC “does not have scientific evidence that suffocating head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment.” [Source: CDC, Treatment of Head Lice]
• Essential oils. The AAP groups tea tree and other oils with home remedies for which “no studies prove they work.”
• Shaving the head. Not needed. Treatment plus combing clears lice without a buzz cut.
• Pet flea products, kerosene, gasoline. Dangerous. Never use them on a child.
• Fumigating the house. The CDC says plainly, “Do not use fumigant sprays or fogs.”

What should I do around the house after finding lice?

Less than you think. Lice need a warm scalp to survive, so focus on the two days before treatment:

1. Machine wash bedding, hats, and clothes worn in the last 2 days in hot water (130°F) and dry on high heat.
2. Soak combs, brushes, and hair ties in hot water for 5 to 10 minutes.
3. Bag stuffed animals and anything you cannot wash for 2 weeks, or simply vacuum them along with the couch and car seats.
4. Wet comb every household member. Treat only those with live lice or close-to-scalp nits.

The CDC notes that “spending much time and money on housecleaning activities is not necessary” beyond these steps. [Source: CDC, About Head Lice]

When should my child see the pediatrician for lice?

Most cases never need a visit. Book one when:

• Two rounds of OTC treatment failed. Live, crawling lice 2 to 3 days after the second permethrin or pyrethrin application usually means resistance and calls for a prescription lotion.
• Your child is under 2. Pyrethrins are not approved under age 2 and permethrin is not approved under 2 months, so let us confirm the diagnosis and pick a safe product or a combing plan.
• The scalp looks infected. Red, swollen, oozing, or crusted sores, tender lumps behind the ears, or a fever over 100.4°F with scalp sores suggest a bacterial infection that may need an antibiotic. See our post on child fever and when to worry.
• You are not sure it is lice. A quick comb check settles it, and we can rule out other common rash types at the same time.

Lice are never an emergency room problem on their own. Go to the ER only for a spreading red streak from a scalp sore, a child who is very drowsy or hard to wake, or any fever in an infant under 3 months. Otherwise a same-day sick visit or a secure video visit, where you hold the comb up to the camera, is the right level of care.

Can my child go to school with head lice in Georgia?

In most cases, yes, and the major medical groups want it that way. The AAP discourages no-nit policies and states that “a child should not miss or be excluded from school because of head lice.” [Source: AAP HealthyChildren.org, Signs of Lice]

The National Association of School Nurses agrees, calling on school nurses to advocate for strategies that “eliminate exclusionary practices and promote positive student outcomes, including reduced absenteeism.” [Source: National Association of School Nurses, Head Lice] The CDC adds that students with head lice do not need to be sent home early; they can finish the day, start treatment that evening, and return the next morning.

Georgia has no statewide school lice law, so each district, and sometimes each school, writes its own rule. Some only ask that treatment begin before the child returns. Others still ask for a nit check by the school nurse. Read your school’s handbook or call the clinic nurse before you assume. If your school requires a note confirming treatment, we can provide one at our Marietta, East Cobb, Alpharetta, or Cumming office.

How Sun Pediatrics can help

We treat lice as a routine problem, not a crisis. Every physician is board certified, and our team cares for children from birth through 18.

If over-the-counter treatment has failed, bring your child in for a same-day sick visit. We can confirm the diagnosis, check the scalp for infection, and send a prescription for ivermectin, spinosad, or another lotion to your pharmacy the same afternoon. We are open Monday to Thursday 8:00 to 4:45, Friday 8:00 to 4:15, and our Saturday clinic runs 9:00 to 12:00 on the 1st and 3rd Saturday. New patients are always welcome.

Request an appointment online or call 678-501-5601. Same-day sick visits are held every day at all four offices.

Frequently asked questions

Does my whole family need to be treated?

No. Check everyone with a wet comb and treat only those with live lice or nits close to the scalp. Treating people who do not have lice adds to resistance for no benefit.

Why is my child still itchy after treatment?

Itching is an allergic reaction to louse saliva and can last a week or two after every louse is gone. Itching alone does not mean failure. Live, crawling lice several days after treatment do.

Can lice come from swimming pools or our dog?

Neither. Lice cling tightly to hair in water and do not swim between kids, and pets do not carry human head lice.

Do I need to retreat after a one-time prescription lotion?

Usually not. Ivermectin, spinosad, and abametapir are labeled as single applications. Do a wet comb check 7 to 10 days later and call us if you find anything moving.

This article is for general information and is not medical advice. Contact your pediatrician for care specific to your child.