Head lice- Pediatric Care Plan

By Chelsea Johnson, MD, FAAP
Medically reviewed checkmarkMedically reviewed
June 18, 2019

Patient Instructions/Care Plan Information

If you have any other questions about head lice or the treatment we discussed today, please let me know. Attached is a detailed care plan that includes more information about head lice as well as things you can do to help your child get back to school. I hope your child feels better soon and thanks for choosing us!

What are head lice?

Head lice are highly contagious tiny bugs that cling to the human scalp or hair and pass through close contact. They are very common in kindergarten and school-aged children who tend to play in close proximity and share hair brushes, hats, towels or bed sheets.

Lice lay whitish, oval-shaped eggs (‘nits’) on hair shafts near the scalp. It is more common to find nits than live lice crawling on the scalp.


Common symptoms include:

  • Itchiness, a crawling or tickling sensation on the scalp, neck or behind the ears – usually accompanied by scratching
  • Restlessness, difficulty falling or staying asleep 
  • Small red bumps, scratches or sores on the scalp, neck, or shoulders
  • Occasionally, the lymph nodes behind the ears or in the neck may be swollen and tender


If your child is displaying any of the above symptoms or if you think they have lice, examine the scalp for lice and nits using a fine-toothed comb (louse comb) under a bright light with a magnifying glass, if possible. 

Diagnosis requires seeing a louse or a nit on the scalp. 

If you find lice or nits, notify the school nurse, teacher, or day-care provider. Your child will be able to return to school once they’ve started treatment.

Home treatment and management strategies

Head lice can be treated with over-the-counter (OTC) topical medication, prescription drugs, and/or home remedies..

OTC medication is usually effective at treating lice. You can try one of these:

  • Pyrethrins (A200, Pronto, R&C, RID, Triple X) 
  • Permethrin lotion 1% (Nix)

Always use these medicines exactly as directed (and never in greater quantity or more frequently than recommended). 

  • Do not use a conditioner on the hair before applying the lotion as it protects the lice from the lotion.
  •  Do not wash your child’s hair for 1-2 days after treatment.
  • After the treatment, do the following:
  • Your child wears clean clothes 
  • Wash all clothes, bed linens, and towels in hot water (greater than 130°F. If possible, dry them using the hot cycle for at least 20 minutes.
  • Wash any object your child came into contact with during the past 48 hours in hot water for at least 5 minutes.
  • Seal potentially contaminated but non-washable objects in plastic bags for 2 weeks (lice die within 2 days; nits will hatch and die within 2 weeks).
  • Vacuum your floors and furniture
  • Examine the hair and scalp of household members (treat them if they have it)
  • Avoid sharing combs, hairbrushes, hats, towels, bedding, clothing, headphones, stuffed toys, or other items with someone who has head lice.
  • Reapply in 7-10 days to kill newly hatched lice (as the lotion only kills living lice, not the eggs).
  • DO NOT use it on children younger than 2 years [Ivermectin (Sklice) 0.5% lotion is approved for ages 6 months and older].
  • You do not need to fumigate or fog your home.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.