Head Lice in Children — Medicaid (QUEST) Accepted

Finding head lice on your child sets off an instant itch and a wave of worry — but take a breath: lice are common, they are not dangerous, they do not mean your home is dirty, and they are very treatable. Here is what actually works and what the current guidance says about school.

What head lice are

Head lice are tiny insects that live on the scalp and feed on blood. They spread mainly by direct head-to-head contact, which is why they move through classrooms and slumber parties. The main symptom is itching; you may see the lice or their eggs (nits) glued near the base of hairs.

The school question — updated guidance

Old “no-nit” policies kept children home unnecessarily. The Centers for Disease Control and Prevention now advises that a child with head lice does not need to be sent home early — they can finish the school day, be treated, and return to class after starting treatment. This spares kids missed school and the stigma that used to come with lice.

How we approach it at Ohana Care Clinic

Most lice are treated with over-the-counter medicated shampoos containing permethrin or pyrethrins, following package directions and a repeat treatment if live lice remain after several days. The CDC advises checking with a provider before treating very young children, and prescription options (such as malathion or ivermectin) exist when over-the-counter treatments fail. Combing out nits with a fine-toothed comb and washing recently used bedding and hats helps. We approach it matter-of-factly and without blame — this is common, and it is fixable.

Getting care by telehealth

Most of our care at Ohana Care Clinic happens by secure video across Hawaiʻi. A new primary-care or pediatric patient is seen in person for the first visit at our Hilo clinic; after that, many follow-ups and quick questions work well by video. When your keiki has a rash, sting, or other concern, a photo during a video visit often tells us whether they need to be seen in person.

When to get help now

Call 911 or go to the nearest emergency room for trouble breathing, swelling of the face or lips, widespread hives, fainting, or any reaction that looks life-threatening after a sting or new exposure. When in doubt, call us at (808) 867-8002 or use our symptom checker for after-hours guidance.

Medically reviewed by Donna Leonard, MSN, APRN, FNP-C, pediatric nurse practitioner, and George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP, President & Owner of Ohana Care Clinic.
Date published: July 2, 2026 · Last reviewed: July 2026 · Citations verified: July 2026

This article is general health education from Ohana Care Clinic, reviewed by Donna Leonard, MSN, APRN, FNP-C, and George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP. It is not a substitute for a personal evaluation by a qualified clinician who knows your child’s situation, and reading it does not create a provider–patient relationship. If you think your child may have a medical condition, reach out to us or another licensed provider. In an emergency, call 911.

References

Centers for Disease Control and Prevention. (2024). Treatment of head lice. https://www.cdc.gov/lice/treatment/index.html

Centers for Disease Control and Prevention. (2024). About head lice. https://www.cdc.gov/lice/about/head-lice.html