Treating lice can be difficult. They may recur if people miss eggs, also called nits, or if treatment does not kill every louse. The best lice treatment for kids involves killing all the insects and manually removing their eggs.

One of the challenges of treating lice is that over-the-counter (OTC) treatments only kill lice, not their eggs, which can then hatch. For this reason, many people have to treat lice in children more than once. Removing the eggs by combing them out of the hair can reduce the chances of recurrence.

The American Academy of Pediatrics (AAP) advises only treating children with lice symptoms, not all those who have experienced exposure. It suggests treatment generally begins with using pyrethroids, available in various lice shampoos. Several OTC products can kill lice.

Because head lice are not typically dangerous, parents and caregivers do not need to panic if initial treatment does not remove them.

Read on to learn about the best lice treatment for kids.

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Pyrethroids include the two drugs the Food and Drug Administration (FDA) has approved for OTC lice treatment. The AAP recommends beginning with pyrethroids if there is no confirmed or suspected pyrethroid resistance in the community.

Both groups of drugs are effective, though lice can be resistant to them. This is likely if the lice do not die following their use. If lice die and then reappear, it usually means eggs have hatched after the removal of the insects.

Pyrethroids include the following:


Pyrethrins, such as Rid, Triple X, and R&C, can kill live lice but not eggs. A child may therefore need a second treatment 7–9 days later.

They are generally safe for children over 2 years old but unsuitable for people with ragweed or chrysanthemum allergies. Resistance to pyrethrins may be increasing.


Permethrin 1%, present in a shampoo product called Nix, also kills lice but not eggs. However, it may continue killing newly hatched lice for a few days after treatment. Parents and caregivers may need to retreat children 9 days later to kill other newly hatched lice.

Permethrin is safe for children over the age of 2 months. Resistance is possible, but researchers do not have data on how common it is.

Which one to choose?

When choosing a pyrethroid shampoo, it may help to look at other ingredients, especially if a child has a specific hair care regimen, such as avoiding silicones or drying alcohols. Some shampoos also include detangling agents or conditioners that may help with combing the hair and removing lice eggs.

It is also safe to choose a lice shampoo solely based on which one is available.

Both groups of drugs do not kill eggs, which can reduce their long-term effectiveness. A person may wish to look into other treatments for lice.

If there is resistance to pyrethroids in the community and a child is younger than 6 months old, the AAP recommends manual removal of lice and eggs with a comb.

No approved OTC treatments can entirely kill lice eggs, though some may kill newly hatched lice. For this reason, removing eggs with a comb after treatment is essential. This reduces the risk that the eggs will hatch. If they do, it helps lower their number.

Caregivers may choose alternative approaches or home remedies for lice treatment, such as using occlusive agents that aim to suffocate the lice. These can include:

People should note that these treatments are less effective, and the AAP has not approved them for lice treatment.

Learn more about home remedies for lice.

When OTC drugs do not work or a child cannot safely use them, some prescription medications can help.

If a child is more than 6 months old but younger than 6 years and there is resistance to pyrethroids, one of the following prescription remedies may be useful:

  • ivermectin lotion
  • spinosad lotion
  • benzyl alcohol lotion

For a child over the age of 6 years, it is safe to try the prescription drug malathion.

If the first prescription drug does not work, the AAP advises using a different age-appropriate prescription remedy.

It is important to contact a doctor about lice if:

  • a baby younger than 6 months old has lice
  • lice shampoo does not work, even with retreatment
  • a child has a known allergy to common lice treatments, ragweed, or chrysanthemums
  • a child develops an allergic reaction to lice shampoo
  • a child appears to have a reaction to lice, such as red skin, a rash, or sores from scratching the head
  • a child has itchy skin but no visible signs of lice

Treating lice requires killing the insects and removing their eggs. Eggs that remain may hatch, resulting in more lice. Since eliminating all eggs can be difficult, especially in children with long or thick hair and those who resist combing, most lice treatments require retreatment.

All FDA-approved treatments are generally safe. However, if a child experiences a rash or burning, it is important to remove the treatment and try a different option.

It is best for parents or caregivers with questions about treating lice or lice-related reactions to contact a pediatrician.