Head lice are tiny insects that live on the scalp and feed on small amounts of blood. They spread through direct head-to-head contact and are common in school-aged children. Finding nits (eggs) alone does not always mean your child has an active infestation.
Common Findings
• Active head lice: Live crawling lice are seen on the scalp or hair.
• Nits (eggs): Nits within ¼ inch of the scalp may still be viable. Nits farther from the scalp are usually old and no longer active.
• Other scalp conditions: Dandruff, eczema, psoriasis, or hair casts can look similar but are not lice.
✅ You can manage your child's head lice at home when:
• Your child has live lice or recent nits but is otherwise well, without fever, severe pain, or signs of skin infection.
🏠 Home treatment for head lice:
• Apply permethrin 1% (Nix) as directed. Repeat in 9–10 days if live lice are still present. Comb with a fine-tooth nit comb every 2–3 days until no live lice remain. Wash pillowcases, hats, and recently worn clothing in hot water and dry on high heat. Check household members and treat only those with live lice. Children do not need to stay home just because nits remain.
• If permethrin fails after two properly completed treatments, your clinician may recommend prescription options such as spinosad (Natroba), topical ivermectin (Sklice), or malathion (Ovide). Professional lice removal services may also help in difficult cases but are usually not necessary.
• For itching, use cool compresses or an age-appropriate antihistamine if recommended.
• Permethrin 1% (first-line)
• Spinosad 0.9% (≥6 months)
• Topical ivermectin 0.5% (≥6 months)
• Malathion 0.5% (≥6 years; flammable)
• Oral ivermectin may be used only for select resistant cases.
• Lindane is not recommended.
📱 Contact us again when:
• Live lice remain after completing treatment correctly.
• Symptoms worsen or new lice continue to appear.
• Your child develops significant scalp irritation or you are unsure whether this is lice.
🩺 Go to an in-person appointment when:
• There is pus, spreading redness, increasing pain, swollen lymph nodes, fever, or concern for a skin infection.
• The diagnosis is uncertain or treatment-resistant lice require additional evaluation.
🚨 Seek immediate emergency care if your child is:
• Very ill appearing, develops rapidly spreading skin infection with fever, severe swelling, or other concerning symptoms requiring urgent evaluation.
If your gut tells you something is wrong, don't hesitate to reach out. Need help? Reconnect with our on-demand team of medical staff.
If you have any questions, please email us at hello@heypoppins.com or call us at (215) 559-9353.
© 2026 Poppins. All rights reserved | 2093 Philadelphia Pike #4190, Claymont, DE 19703
