Background: Head lice infestation (Pediculosis capitus) is a common public health problem worldwide. It is a contagious condition caused by the human louse Pediculus humanus capitis, an obligate ectoparasite. Objective: To explore the prevalence of pediculosis among the pupils in the elementary schools in Makkah, and to study the risk factors that increase the lice infestation. Methods: A cross-sectional study was conducted in random school girls and boys in different areas in Makkah city. Questionnaire for collecting data with different clinical methods for inspection was done. Results: A total of 705 pupils aged between 6-15 years from 21 different schools participated. About 486 girls and 219 boys participated in the current study. The overall prevalence was 31.2% girls were significantly infested than boys 42.8%, 5.5% respectively (p<0.0001). Age group of 8-11 years in both boys and girls had a significant relationship with lice infestation (p<0.02). Both boys and girls who reside in the middle area were more suspected of lice (p<0.003). High significant was found in Arab race than others (p<0.0001). Pupil whose father has worked was more suspected of lice infestation (p<0.0001), however pupil whose mother is housewife was more suspected of lice infestation (p<0.008). Shared head scarf with others girls had significant different to increase the infestation (p<0.05). The result showed the relationship between smooth hair and lice infestation (p<0.0001). Conclusion: The results obtained in the current study showed the spread of lice in the elementary schools in Makkah and the importance to prepare the comprehensive program for health education besides preparing a strategic plan for control, management, and eradication.