Head lice are tiny insects that live on the scalp (in the hair) and feed on small amounts of blood. They cannot fly or jump — they spread when heads or hair touch. Human head lice only live on humans, so pets cannot get or spread them. 

Lice:

• Small and flat, and hard to see.
• Fully grown lice are 2 to 3 mm long (about the size of a sesame seed).
• Grey-brown in colour. 
• Live close to the scalp.
• Crawl quickly (they don’t fly or jump) and spread through direct contact.

Nits (lice eggs):

• About the size of a grain of sand.
• Brown when alive, but turn white when hatched or dead.
• Stick to the hair close to the scalp.
• Hard to remove.  
• Hatch in about 7 days.
• If you find nits more than 1 cm from the scalp, they are probably dead, hatched, or could be dandruff. (Dandruff is dry skin that flakes off the scalp. Unlike nits, dandruff is white or clear and can be brushed off easily). 

 Where to look for lice and nits?

• Close to the scalp
• Around the ears
• Back of the neck and forehead

Use bright light (like daylight) when checking for head lice.  A magnifying glass may help, but it’s not needed. Part the hair into small sections and comb wet hair to help see the lice and nits better. If you only find nits, look carefully for live lice. If both lice and nits are present, a full treatment is recommended. 

Only treat your child if you see live lice. A pharmacist can help you choose a lice treatment. Check the ingredients and directions carefully. Make sure that the treatment is safe for your child’s age – some shouldn’t be used on younger children.  

Insecticides

• Insecticides are chemicals that kill insects.
• Treatments with permethrin or pyrethrins work well if used correctly.
• Treat your child twice:  
  • Use the first treatment. Then, repeat it 7 to 10 days later.
  • The first treatment kills live lice but may not remove all nits (eggs).
  • The second treatment kills any newly hatched lice.
  • Between treatments, comb out nits and lice daily.
  • If you find live lice 48 hours after the second treatment, contact a health care provider (like a doctor or nurse).

Non-insecticides

If regular treatments don’t work, non-insecticidal options are available. These include:

• Isopropyl myristate
• Dimeticone
• Benzyl alcohol lotion 

These products usually cost more than insecticides. It’s unclear if they are more effective. They often need more than one treatment to work. Always follow the instructions and finish all treatments. 

It may be helpful to wash items that have touched your child’s head for long periods of time, such as hats, pillowcases, brushes and combs. See Cleaning personal items, below. 

If lice keep coming back after treatment, ask a health care provider (like a doctor, nurse or pharmacist) for advice.

Home remedies

Some people try mineral oil, vinegar, petroleum jelly, mayonnaise, or hair gel to treat lice. However, these products haven’t been proven to work.  

Never use dangerous substances!

The Canadian Paediatric Society warns that gasoline and kerosene are extremely dangerous. Do not use them under any circumstances.

To get rid of head lice, it’s important to remove the nits (lice eggs) and comb the hair daily.  After treating lice, removing the nits helps stop them from coming back.

To remove nits:

• Use a bright light and divide the hair into small sections.
• Use a fine-toothed nit comb or your fingernails to gently pull the nits from the hair. Start at the roots and work toward the ends.
• It’s easier to remove nits when the hair is wet. Wipe the nits onto a tissue and put it in a bag to throw away. Afterward, wash your hands with soap and water, and soak the comb in hot water.

Traditional treatments usually work best for lice. But, if you’re on a budget, there are some affordable alternatives you can try. These options can still work well if used correctly.

Combing:

• Combing can be used as a first line of defense. You can use a fine-toothed comb (lice comb) to remove lice and nits (lice eggs) from your child’s hair. Comb wet hair in small sections every 2 to 3 days for 2 weeks. While this method is free, it may not be effective on its own.  

Home remedies:

• Some home remedies may help, but they usually aren’t as effective and should be used with care. (See How to treat lice – Home remedies).  
• You can also use regular conditioner to help make combing out lice easier.  However, if you plan on using a lice treatment, make sure to rinse out all the conditioner first. Otherwise, the treatment may not work as well.  

Preventing lice:

• Teach your child not to share hats, hairbrushes, or hair accessories with others.
• Remind them to avoid head-to-head contact while playing. This can help prevent lice from spreading.
• Check for lice often to catch them early, making treatment easier and quicker.

Insurance coverage or other assistance:

• If you have private insurance:
  • Check your plan to see if lice treatments are covered. You may get reimbursed for treatment costs. Submit a claim to your insurance company.
• If you don’t have private insurance:
  • Some lice treatments may be covered by the OHIP+ program. To find out if a treatment is covered, ask the pharmacist or check online. If it is covered, you’ll need a prescription from a health care provider (like a doctor or nurse practitioner). Once you have the prescription and your child’s health card, you can get the treatment at the pharmacy.
• If you receive government funding through Ontario Works (OW) or Ontario Disability Support Program (ODSP):
  • You may receive lice treatment products low cost or no-cost from pharmacies with a prescription. To check if a treatment is covered, please refer to the Ontario Drug Benefit Program. 
• If you don’t have a health card:
  • Some pharmacies, schools, or community health programs might help. They may offer low-cost or free lice treatments. You can contact them to see what options are available.   
• If you have a social worker:
  • Contact your social worker for help with lice treatment resources.

After treating head lice, clean personal items to avoid getting lice again. Lice cannot survive more than 1 to 2 days away from the scalp. Nits (lice eggs) can live up to 3 days but need warmth to hatch.

How to clean personal items:

• Wash combs, brushes, and hair accessories with hot, soapy water until all lice and nits are gone.  Then soak them in very hot water for 10 minutes.
• Wash clothes, bed sheets, pillowcases, blankets, and towels in hot soapy water then dry them in a hot dryer for 15 minutes.
• For things you can't wash, you can place them in a sealed plastic bag for 14 days.
• You don't need to clean your home more than usual. Don’t use insecticide sprays.
• You don’t need to wash pets – human head lice cannot live on animals. 

Sometimes, lice can become resistant to insecticides like permethrin or pyrethrins. These lice, often called "super lice”, look the same as regular lice but might not be killed with standard treatments.

If you still find live lice after using the treatment, it could be due to:

• Treatment resistance (the lice survived)
• Misdiagnosis (something else is causing the symptoms, or only nits were present, not live lice)
• Reinfestation (lice came back)

In this happens, talk to a health care provider (like a doctor, nurse, or pharmacist) about switching treatments.

To help prevent lice from coming back, comb out nits and lice every day between treatments and clean items that may have touched your child’s head. See How to remove nits (lice eggs) and Cleaning personal items, above.

Alternative Treatments

If standard treatments don’t work, there are other options, such as:

• Isopropyl myristate
• Dimeticone
• Benzyl alcohol lotion

These products may work if used as directed. Talk to a health care provider (like a doctor, nurse or pharmacist) to find the best option for your family.

Most lice cases can be treated at home. In some cases, it’s best to check with a health care provider (like a doctor, nurse or pharmacist) before starting treatment.

See a health care provider if:

• You are allergic to any of the treatment ingredients.
• You are pregnant or breastfeeding.
• You are treating a child under 2 years old.
• You are treating someone with a seizure disorder.
• You are treating lice on eyebrows, eyelashes or a beard.
• The scalp has open sores, cuts, or signs of infection.
• The lice problem does not go away. 

Head lice spread through close contact, but there are simple ways to reduce the risk. Regular checks and good habits help stop lice from spreading at home, school, and in the community.

• Check your child's head regularly.
• Check every day during lice outbreaks at school or daycare, or whenever school or daycare staff ask you to.
• Teach your child not to share items such as:
  • Hairbrushes or combs
  • Hair accessories
  • Headphones
  • Hats or helmets
  • Scarves and neckwarmers
  • Towels
• If one family member has lice, check everyone in the household for lice and nits. Other family members might get them too.
• Inform your child’s school, daycare, or activity group (like sports teams or clubs). This way, other parents can check their children's hair.
• Treat everyone with lice at the same time to prevent lice from coming back.  

Parents should check their child’s hair regularly for lice and nits and treat them if lice are found.  Schools and child care centres should alert parents if their child, or anyone in their class, may have lice. If your child has lice, it’s important to tell close contacts so they can check their hair, too.

Head lice do not spread disease, so there’s no medical reason to keep a child with lice or nits out of school or daycare. However, school boards and child care centres may have rules about children with live lice staying home.

Resources and videos

There are many trusted sources of information on lice treatment and prevention. If you need help, check reliable health websites, talk to a health care provider (like a doctor, nurse or pharmacist).

If you have any further questions about head lice, you can call Health811 at 8-1-1 to speak with a nurse for confidential health advice at no cost.  

Useful resources:

• Canadian Paediatric Society
• Head Lice Fact Sheet (English)
• Head Lice Fact Sheet (Arabic) *updated version available soon

• Video: Head lice (from Alberta Health Services)