So, you're brushing little Annie's golden locks and you spot them: a tiny louse here, a teeny nit there, and suddenly you're seeing nits and lice everywhere (and furiously scratching your own head). Maybe Johnny's been sent home from school with that dreaded note – a classmate is infested, and Johnny (not to mention the rest of the family) could be next. So how do you get rid of these pesky pests? Do you buy the tough-sounding Lice Breaker, Lice Attack or Lice Blaster, go for the medical-sounding KP24, HL7, or Pyrenel, or heed your inner hippie and buy into the gentler-sounding Wild Child, Ecokid or Neutra? Here's all you need to know.

Insecticide treatments

Insecticidal treatments are registered with the Therapeutic Goods Administration (TGA), which means they are evaluated as both effective and (relatively) safe. To make sure the product you choose is registered with the TGA, check for the AUST-R number on the label.

Lotion versus shampoo

Products in lotion form seem to be more effective than their equivalent shampoos.

Why isn't it working?

Lice are wily creatures, and they're becoming resistant to conventional insecticides. Resistance can vary region by region. It's an expensive and time-consuming exercise, but the bottom line is if one product ain't working, try another. 

Other reasons a treatment might fail:

  • You're not using enough of it to cover the scalp and hair.
  • You're not repeating the treatment after 7 to 10 days (to kill nits, which often survive the first application).
  • You're getting reinfested due to head-to-head contact with another person.

Herbal treatments

Herbal head lice treatments contain various combinations of essential oils and herbal extracts. Most haven't been clinically tested or independently assessed for effectiveness or safety. If your child is heavily infested, you might want to try an insecticide-based product before going herbal.

Do they work?

The short answer is maybe. If you're having no luck with insecticide treatments, some herbal treatments are worth a try. Many herbal ingredients have been shown to be effective in lab tests or small clinical trials (though not on children's heads).

Comb and conditioner method

If you don't want to fog your child, the insecticide isn't working, or you just prefer good, old-fashioned elbow-grease to detect and treat light infestations, the comb and conditioner method can also be very effective – if done right. It's very labour intensive and good technique is vital. And if you're using it as your sole treatment method it needs to be carried out at regular intervals for two to three weeks to get rid of all lice and eggs.

Here's how to do it:

  1. Apply any type of thick, white conditioner to dry, brushed (detangled) hair and comb through with a normal comb. The conditioner stuns lice for up to 20 minutes and makes it difficult for them to grip the hair or crawl around.
  2. Systematically comb sections of the hair from the roots to the ends with a head lice comb.
  3. Regularly wipe the comb onto a tissue to check for lice and eggs.
  4. Comb every part of your child's head several times.
  5. If you find live lice or nits, you need to treat your child's hair. You can recognise live eggs because they'll pop when you squeeze them.
  6. Repeat regularly for two to three weeks.

Which lice comb is best?

There's a bevy of different combs available and you'll probably need to experiment to find the best one for you. Generally your best bet is a comb with metal, cylindrical teeth.
  • Combs with metal, cylindrical teeth are gentle on scalp and hair, and when used with conditioner they remove most lice and most eggs. While more expensive than plastic, they last longer.
  • Those with plastic teeth are gentle on scalp and hair, and when used with conditioner they remove most lice and some eggs.
  • Metal, flat teeth can damage the hair shaft, and when used with conditioner they remove some lice and few eggs.
  • Electronic combs (which kill or stun lice with an electric shock) should only be used on dry hair, and remove most lice, but no eggs. They also can't be used on babies and shouldn't be used by people with epilepsy, heart disease, or a pacemaker. 

Stay safe

  • No insecticide or herbal product is completely safe. Both can be toxic if swallowed.
  • Both can cause skin irritation, especially if the skin is sensitive or broken. Use them in a well-ventilated area and apply with gloves.
  • All products can also cause eye irritation, so use a visor or cover the eyes.
  • Any product containing alcohol/ethanol or that's packaged as an aerosol is highly flammable so don't use it near a naked flame.
  • If you have an adverse reaction to any type of TGA-registered or listed product, report it to your pharmacist or GP or call the Adverse Medicines Events Line on 1300 134 237.

Top 7 lice treatment tips 

  1. Check for live lice or nits (the live nits will be "cemented" onto the hair shaft and pop if squeezed) before resorting to insecticidal treatment. If you're only mildly affected, the comb and conditioner method is the safest.
  2. Use all treatments as directed. Check how much to use, how long the treatment should be left on and whether to rinse the hair afterwards.
  3. No treatment kills all lice in one hit – you need two applications 7 to 10 days apart. The first treatment kills live lice; the second, the young lice hatched in the interim.
  4. Tell close contacts and report your situation to your kids' school immediately. Synchronised treatment prevents reinfestation.
  5. There's no need to treat the whole family if they don't have live lice and eggs, and the risk of transmitting lice by sharing hats, hairbrushes or bed linen is low. To be safe, hot wash (at least 60°C) pillowcases, or dry them on the hot setting in your clothes dryer – heat kills lice and nits.
  6. No product prevents head lice.
  7. Tying back long hair can help prevent the spread of head lice.