Wondering how to remove head lice? Try these surefire techniques from a school nurse who has seen it all (and then combed it away).

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girl being treated for lice
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So your child has head lice. That's not too surprising, since the Centers for Disease Control and Prevention (CDC) estimates that 6 million to 12 million children – mostly 3- to 12-year-olds – get head lice annually. These parasitic wingless insects live only on the human head and are extremely contagious. Kids get lice when their heads come into close contact, usually through actions like hugging, crouching around a video game, playing sports, or doing each other's hair.

Signs of lice in children may include a tickling feeling in the hair, sores from scratching, and difficulty sleeping, as head lice are most active in the dark. The itchiness mostly comes from human allergy to louse saliva as they feed on the blood of the head. (Some kids aren't allergic, and in these cases, you'll probably just spot the bugs.)

A louse is a tan to grayish-white bug that's about the size of a sesame seed; nits are grayish eggs the size of a grain of salt, and they're attached to hair shafts a few millimeters from the scalp. Lice "hot spots" are the top of the head, behind the ears, and the nape of the neck.

If your kid has lice, other family members might also have it. You'll need to treat those who do in order to solve the issue – and that’s where things can get tricky, says Sally Kelly, R.N., a school nurse who makes lice-removal house calls in and around Chatham, New Jersey. You can go to the pharmacy and buy over-the-counter anti-lice shampoo, but the pesticides in these shampoos aren't 100 percent effective. Kelly uses a more natural method that, when closely followed, works for her every time. "Not only is it more effective, but you also don't apply chemicals to your child's head," she says.

How to Remove Head Lice

Here is a four-step process for head lice removal, helping your child beat an infestation easily.

STEP ONE: First Comb-Out

Kelly begins with a very thorough combing with the LiceMeister comb; its teeth are 1 to 2 inches long and very close together, which helps snag nits and lice. If your child has thin hair, first dip the comb in conditioner. Any cheap, thick kind will do, says Kelly; white conditioner works best because you can see the bugs against it more easily. Then dip it in a dish of baking soda, which adds abrasion. For coarse hair, dip the comb only in conditioner. Work through very small sections of hair at a 45-degree angle – up, down, back, forth – while also making sure to run the comb along the scalp.

STEO TWO: Second Comb-Out

Now wet your child's hair. Apply conditioner directly to the hair and wrap it in a towel to remove the bulk of the water, leaving the conditioner in. Comb the hair again with the nit comb, this time working through slightly larger, inch-thick sections. Lice are sensitive to light, and they're fast. They'll scurry the minute you expose them, so work quickly while still making sure to cover every area. When you're finished, boil the comb for a few minutes or disinfect it with a 20-minute dip in ammonia (or you could run it in the top rack of the dishwasher). Repeat this step every day for five days. Change your child's pillowcase and bath towel on each of these days.

STEP THREE: Delouse the House

On the first day, wash your child's bedding. Also dry pillows, stuffed animals, and the comforter on high for 20 to 30 minutes. Wash all brushes on the top rack of the dishwasher, or soak them in ammonia for 20 minutes, or boil them for a few minutes. Roll a sticky lint brush over the top half of the bedding each day for five days. Vacuum rugs or furniture your child has lounged on in the past 48 hours – the maximum length of time a louse can live off of the human head.

STEO FOUR: The Follow-Up

Two weeks from your first comb-out, do it one more time. "This is the part people don't do, because they think they've taken care of everything after those first few days," says Kelly. But do not skip this step! "If you left just one nit, the whole process can start over again. And you do not want that."