A practical guide to treating head lice with conditioner and wet combing, understanding the lice life cycle and checking the family
Head lice are one of those things I had never given much thought to until they started doing the rounds at my daughter's school.
Then we got them.
We treated them, cleared them out and thought that was the end of it. Then they came back. After several rounds of lice appearing at school and subsequently making their way home again, I decided it was time to understand exactly what we were dealing with rather than simply reaching for another bottle of head lice treatment.
It turns out that getting rid of head lice is not particularly complicated. The difficult part is understanding their life cycle and being methodical enough to break it.
One of the simplest ways to do that doesn't require insecticide at all.
It requires conditioner, a good lice comb and a calendar.
First, lice and nits are not the same thing
The terminology gets mixed up surprisingly often.
- Head lice are the actual insects. They live close to the scalp and feed on small amounts of blood.
- Nits are their eggs. They are tiny and firmly attached to individual strands of hair, usually close to the scalp.
Finding nits does not necessarily mean there are still living adult lice on the head. Some may already have hatched and the empty casing can remain stuck to the hair.
Finding a live crawling louse, however, confirms an active infestation.
Lice cannot fly or jump. They crawl, with most transmission occurring through direct head-to-head contact. That is one reason they spread so easily among young children.
It also has nothing to do with whether someone's hair is clean or dirty.
The trick is understanding the lice life cycle
This was the part that made treatment finally make sense to me.
A female head louse lays eggs close to the scalp. Those eggs generally hatch roughly six to nine days later.
The newly hatched lice are called nymphs. They look like tiny versions of adult lice and take about another week to mature.
Once mature, female lice can start laying more eggs and the cycle continues.
This creates an obvious problem with any treatment that removes or kills the lice you can see but misses some of the eggs.
You can clear the head today, congratulate yourself on a job well done, and then have another batch quietly hatch several days later.
That is why treating head lice properly is a process rather than a single event.
The conditioner and comb method
Mechanical removal is one of the simplest ways of treating head lice.
Rather than relying on an insecticide to kill them, you physically remove the lice and eggs using ordinary hair conditioner and a fine-toothed lice comb.
The conditioner doesn't magically poison the lice. It temporarily restricts their movement, making the normally very quick insects much easier to catch with the comb.
It also makes the hair considerably easier to work through.
White conditioner is particularly useful because brown or grey lice are much easier to see against it.
You don't need a cupboard full of head lice products for this method. The useful things are:
- A good metal lice comb — I recommend the Nit Free Terminator Comb.
- A detangling brush such as a Tangle Teezer Wet Detangler.
- Cheap white conditioner.
- A few hair sectioning clips if the hair is long or thick.
The Day 1, 5, 9 and 13 method
One established wet-combing schedule is to thoroughly comb the hair on:
Day 1
Day 5
Day 9
Day 13
Then perform another careful inspection on Day 17.
There is some variation in official advice. Current NSW Health (Australia) recommends repeating the conditioner-and-comb process every two or three days until no lice or nits remain, while current NHS (UK) guidance uses the Day 1, 5, 9 and 13 schedule.
Both approaches are based on the same principle.
You are not relying on removing every single viable egg during the first treatment. Instead, you repeatedly remove newly hatched lice before they have enough time to mature and continue the breeding cycle.
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DAY 1 REMOVE WHAT IS THERE The first thorough comb removes adult lice, nymphs and as many eggs as possible. Removing adult females is particularly important because it stops them laying more eggs. |
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DAY 5 CATCH THE EARLY HATCHERS Some eggs that survived the first comb may now have hatched. These tiny nymphs are removed before they have matured. |
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DAY 9 CATCH THE NEXT GROUP More of the remaining eggs may have hatched during the intervening days. Another thorough comb removes them. |
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DAY 13 CATCH THE STRAGGLERS The final scheduled treatment catches lice that hatched later in the cycle. |
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DAY 17 CHECK YOUR WORK Go through the hair carefully again. If you still find live crawling lice, treatment needs to continue. Don't assume every white speck attached to the hair means treatment has failed; old or empty nit casings can remain attached long after the louse has gone. |
How to wet-comb properly
The technique matters almost as much as the schedule.
1. Use plenty of ordinary conditioner
Apply a generous amount of normal hair conditioner. Cheap conditioner is perfectly adequate. In fact, NSW Health specifically suggests using an inexpensive white conditioner because you are likely to use quite a lot of it.
Make sure the hair close to the scalp is well coated, as this is where the lice spend most of their time.
2. Detangle the hair first
Do not immediately attack tangled hair with the lice comb. Use an ordinary comb or detangling brush first and remove knots until the hair can be combed easily. For long or easily tangled hair, something like a Tangle Teezer Wet Detangler or Wet Brush works particularly well on conditioner-saturated hair.
For long or thick hair, divide it into manageable sections with clips.
This is important because randomly combing through the top layer of hair makes it very easy to miss areas completely.
3. Use a proper fine-toothed lice comb
A rigid, fine-toothed metal lice comb is worth buying. I prefer the
Nit Free Terminator Comb,
which uses tightly spaced stainless-steel teeth with micro-grooves designed to give additional grip on lice and eggs attached to the hair.
A simpler long-tooth metal comb such as the
KP24 Long Tooth Headlice Comb
is also a perfectly reasonable budget option, particularly for thick or long hair.
- Start as close to the scalp as possible and draw the comb all the way through to the ends of the hair.
- Work methodically around the entire head in small sections rather than jumping from one area to another.
- Pay particular attention to behind the ears and around the back of the neck, where eggs are commonly found.
4. Wipe the comb after each pass
Keep some white paper towel or tissue beside you. After each pass through the hair, wipe the comb onto it. This serves two purposes:
- First, it removes anything caught in the comb rather than potentially putting it straight back into another section of hair.
- Second, it lets you actually see what you are finding.
Adult lice are relatively easy to identify. Newly hatched nymphs can be extremely small and are much easier to spot against a white background.
5. Keep going until the section is clean
One pass through each section isn't enough.
Comb it several times, wiping and checking the comb as you go.
When nothing further is appearing on the paper towel, move on to the next section.
Long or thick hair can take quite a while. There isn't really a shortcut here. A careful 30 or 45 minutes is considerably more useful than a hurried ten-minute comb that misses half the head.
Don't treat the house like it has fleas
This was another useful thing to learn.
When people discover head lice, the natural reaction is often to start stripping beds, disinfecting bedrooms, washing every stuffed toy and contemplating setting fire to the sofa.
Fortunately, head lice are much more dependent on us than that.
They are adapted to living on the human head and feeding regularly. Once separated from a person, adult head lice generally die within one or two days. They do not establish colonies in carpets, mattresses or furniture.
That means there is no need to spray insecticide around the house or undertake a major disinfection exercise. Basic hygiene is enough.
Wash or clean things that have been in close contact with the person's head, such as pillowcases, hats, hair ties, combs and brushes. Brushes and combs can be cleaned thoroughly in hot soapy water. There is far more value in spending another 20 minutes carefully checking everyone's hair than spending three hours disinfecting the lounge room.
Check everyone else in the house
If one person has head lice, check everyone who has been in close contact with them. That does not mean automatically treating every member of the family.
Look for live lice.
If another person has them, treat them at the same time. Otherwise it becomes very easy for successfully treated family members to simply pass lice backwards and forwards between one another. Regular comb checks are also worthwhile during a school outbreak, particularly with young children.
Chemical treatments can work, but follow the instructions
There are also medicated head lice treatments available from pharmacies and supermarkets. They can work well, but they need to be used exactly according to the instructions.
An important detail is that some products kill live lice more effectively than they kill eggs. That is why many treatments require a second application roughly a week later. Resistance to some insecticides is another reason a treatment may appear not to work.
If you use a chemical treatment and still find healthy live lice afterwards, repeatedly applying more of the same product is not necessarily the answer. Speak with a pharmacist and consider either a different active ingredient or mechanical removal.
And don't combine treatments or use them more frequently than directed in the hope that "more" will work better.
You don't need to remove every old nit to know treatment worked
This is another source of unnecessary panic. Nit casings are glued remarkably firmly to hair. Unlike dandruff, they don't simply brush away.
As the hair grows, old nits gradually move further away from the scalp. Finding one stuck several centimetres down a strand of hair does not necessarily mean there is an active infestation.
The most useful question is:
Can I find a living, crawling louse?
That is a much better indication of whether treatment is still required.
What finally made sense to me
The biggest change in the way I approached head lice was realising that treatment isn't about finding the strongest product and killing everything in one hit.
It is about breaking the life cycle.
- Remove the adults.
- Come back before newly hatched lice can mature.
- Repeat the process until there is no generation left to replace them.
For us, that also means keeping the lice comb handy whenever there is another notification from school rather than waiting for scratching to start.
Head lice are annoying, particularly when they keep being reintroduced through school or childcare, but they are not particularly mysterious. A bottle of conditioner, a decent metal comb and a little persistence can do an impressive amount of damage to their plans.
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