Kids shouldn’t be sent home for lice, but schools can’t ignore the issue either

Last night, my 3-year-old daughter made soft, singing noises while she dipped a plastic boat in and out of the bubbles of her bath, oblivious to my actions of raking a fine-toothed metal comb through her mop of curls that reach her shoulders when they are wet.

Just a few months ago, the sight of a hairbrush in my hand caused her to shriek. Bath time was a battle. I was certain her first memories would be the pain from my tugging tangles out of her hair. Then, that fateful day came when the sun shone on her little forehead, still from sleep in her car seat. I bent over to carefully unbuckle her and saw the telltale bug crawling through her blond curls. Head lice.

I was no stranger to this terror. My oldest daughter seems to attract them. Maybe it is her mass of light-brown hair, so thick I can barely get a comb through it. Maybe it is her many invitations to sleepovers with several friends where they try on five different outfits. When I first discovered my oldest had them, my youngest was a newborn. I was on my own, barely making ends meet, scrambling to find work I could do at home to pay rent. Dropping $20 on a tiny bottle of shampoo that claimed to kill the bugs that had invaded our house was an expense I could not afford. Plus, I had to wash and dry everything I could — including stuffed animals — on high heat, vacuum, and repeat a week later. I bagged most of it instead.

My oldest had been in kindergarten that year, and I faintly remembered a line in the classroom newsletter telling me they had a report of lice. There was not any mention of ways to check for it, or how to prevent it. This was several years ago, when the school nurse came around with her flashlight to check every head. I knew if she found any, she would send those kids home because of the district’s “No Nits” policy. So, I didn’t worry. Lice happened to other people. Not my daughter, who stayed in the bath so long, her fingers wrinkled before I convinced her to get out of the tub.

When I found lice last spring, I sent an email to my daughter’s teacher. I half expected her to tell me that, even though I had used the shampoo and spent an hour combing her hair, my daughter would have to stay at home until the nits were gone. The school nurse called me instead.

“We don’t send students home anymore,” she cheerfully said, explaining that only 10 percent of lice are transferred at school. Because of this, they no longer checked students, did not call parents to pick up their children and did not notify the parents there had been a report. My daughter’s teacher did not send out a note, email or even include the infestation in the newsletter that week.

I applauded the idea of not sending children home. Low-income families don’t need the added hardship of missing work on top of the expense of ridding themselves of lice and nits, along with the stigma their kid would experience of being the one with cooties. The expense of lost wages, in addition to the added expense of laundry and buying shampoos and kits, could mean less rent money, not just an inconvenient afternoon. But shouldn’t there be a system in place to notify parents in the chance their child is part of that 10 percent?

As kids are back in school, connecting with friends, and putting their heads together, either by taking selfies or studying, lice transferring from one head to the next seems inevitable. But there was no mention of that possibility in the student handbook my daughter’s school sent home.

In deciding to allow students who have lice to come to school, the flip side should be educating parents on what to look for, how to prevent them and how to get rid of them without spending $50 on chemical-laden shampoos, salon treatments and loads of laundry. Keeping lice out of schools should be a herd immunity type of attitude. Schools should send home brochures with a plastic comb attached in an envelope. If every parent knew that the best way to prevent lice from spreading is by looking for them, cases decrease dramatically.

Nobody wants to admit their kid is the one with lice. Not only because of the work involved in getting rid of them, but because lice are still associated with dirt, grime, neglect and often poverty. Yet, when stomach bugs run rampant, we all accept that it will run its course and we will be spending a day doing laundry along with everyone else. If parents admitted they are part of the 6 million to 12 million cases of lice reported a year, maybe it’ll be on par with stomach bugs, and not shrouded in secrecy.

More than that, I want a way for parents to notify the school their child has lice, anonymously if needed. I want to get a text message every time this happens so I know to check more than once a week for a while. If parents know how many times others are finding lice on their kids’ heads, maybe other parents will not hide their own discoveries in shame.

How to combat a case of psychosomatic lice after receiving the dreaded letter from school

One would think the worst part of lice would be actually having (gag) lice. Not true for me. Since my oldest started elementary school, the biggest little injustice in my life has been opening an email that reads, “There has been one reported case of lice in first grade” — and feeling my scalp begin to crawl. Then I spend the following two weeks obsessing when the wind blows through my hair or my toddler tries on a fire helmet at the children’s museum. The terror descends around 10 times a year, between elementary school, after-school programs, preschool and camps.

I squirm because I know my kids will sit alongside peers wearing crowns of unborn lice now that most school districts exclude only children with live bugs. The American Academy of Pediatrics guidelines recommending abandonment of “no-nit” policies make sense. Eggs firmly affix to shafts of hair and even if one were to hatch during recess and wind up on another child, lice present no health hazard.

Still, my children’s proximity to nits rubs me the wrong way. And rubs again. Now over there. And here. And back there again. Even if no one in our family shows signs of pediculosis, I itch.

Known by psychologists as a “hysterical condition,” psychosomatic itching is nonetheless a “genuine physical affliction caused by emotional anxiety,” says San Francisco-based psychologist Juli Fraga. That means the problem is real-ish.

Luckily, there are ways to vanquish phantom parasitic insects — and they’re much more pleasant than the protocol for live ones.

Prevent dry scalp

My fear doesn’t need much help making my head itch, since it’s already dry, thanks to the hormonal fluctuations of pregnancy and nursing. Dandruff also makes it more difficult for my husband to rule out lice on a visual inspection.

Maritza Buelvas of The Every girl recommends combating dry scalp with pre-wash treatments such as scalp massage and DIY hair masks. She also suggests trying a natural shampoo, topical spot treatments and general hydration. If dryness rises to the level of scalp psoriasis, doctors can inject steroids into problem areas, prescribe medication or recommend phototherapy involving lasers or natural sunlight. Tea tree oil offers a win-win, reportedly both hydrating the head and some say actually repelling lice.

Restore perspective

 A removal company in Atlanta, says: “If your head did not itch the minute before hearing the word lice, . . . the itching you are experiencing is in your head, not on your head.” For another good reality check, I ask myself whether my sleep loss comes from trouble falling asleep or if I’m actually being awoken. The latter should only happen with live critters.

Though some folks with lice remain asymptomatic, when they do itch, it’s usually specific to small bumps that stay put, such as mosquito bites. Genuine crawling sensations also tend to be localized, feeling like tiny, slow ants moving through one’s hair. Generalized itchiness, I constantly remind myself, is more likely to be psychosomatic.

Drink alcohol

If sober self-assessment doesn’t work, I drink a glass of wine. Maybe three. I try to relax and otherwise engage my consciousness. If I manage to focus on a conversation about my recently divorced friend’s new paramour or lose myself in George Clooney’s suave mischievousness for a few hours only to have the itching restart as soon as the call ends or the credits roll, I have my answer.

Blow-dry hair

Here’s the thing that keeps me scratching my head. They could be in there. Lurking. Feasting.

There is another way. Just as only abstinence can prevent 100 percent of unwanted pregnancies, only painstaking removal of bugs and eggs can ensure complete eradication of head lice. That doesn’t mean other methods are worthless.

Now, whenever I itch, I blow-dry my hair and congratulate myself on having desiccated potential eggs and maybe some lice. If my head still crawls the next day, I do it again knowing the odds only improve each time.

Applying heat to my hair may not adequately treat an infestation, but it has been 100 percent effective at putting my mind at ease — which, of course, is what stops psychosomatic itching.

Mutant lice are infesting kids all over the US

Mutant lice sound like the star of a low-budget horror film, but they're a real problem being found around the nation.

These insects' mutations seem to make them resistant to some over-the-counter treatments typically used to get rid of lice, sold under brand names including Elimite and Nix.

While some treatments are no longer effective in some cases, methods that do work are still available, so you just might need to ask your child's doctor.

Lice are a parasitic insect that live in human hair on our scalps, eyebrows and eyelashes, and feed off our blood.

Lice can't jump; they can only crawl, so they spread through head-to-head contact. They have adapted so well to living on us that their feet are especially evolved to cling to human hair, even during washing.

An infestation can feel like a tickling, itchy sensation on the head, and can be diagnosed by looking for adult or nymph lice on the scalp or hair, according to the U.S. Centers for Disease Control and Prevention. It's tough to know how many people get head lice, but among kids aged three to 11, it's anywhere from 6 million to 12 million infestations in the United States every year, according to the American Association of Pediatrics.

Every parent dreads the moment their child comes home from school scratching her head, and the thought that these lice may not not be killed off with over-the-counter treatments is even more unsettling.

A growing problem

To figure out how lice are evolving resistance, biologist Kyong Yoon from Southern Illinois University, Edwardsville and his team tested the genes of head lice collected from 30 states. In samples from 25 of those states, they found that the lice had a gene that protects them against a lice treatment called permethrin.

In four other states — New York, New Jersey, New Mexico, and Oregon — the lice showed some level of resistance, but it hadn't reached a point that would render these treatments useless.

Yoon reported his results at a meeting of the American Chemical Society on August 18, and he has been tracking the spread of resistance in the U.S. since 2000. These latest results, though, haven't been published in a peer-reviewed journal.

With each round of research, Yoon and his team noted that lice are getting more and more resistant to permethrin. In their latest study, published last year in the Journal of Medical Entomology, they noted that until reports from 1995 indicated that permethrin was at least 96% effective, but a 2001 report described it as only working 80% of the time.

That rate seems to have dropped to as low as 28% effectiveness in some places, they wrote.

Dr. Jason Yaun, an assistant professor of pediatrics at the University of Tennessee Health Science Center in Memphis who wasn't involved in the research, told MedPage Today that permethrins are still the most safe and effective treatment. And they're still what the CDC recommends as a first resort.

The Mayo clinic also suggests that multiple treatments may be needed, since permethrin won't kill off freshly laid lice eggs, so parents need to make sure that the treatment is being used correctly.

But even if some cases in certain areas do still react well enough to lice lotions now, there's no reason to think that will last. The spread of mutations to permethrins over time could become a much bigger problem, Yoon argues.

"If you use a chemical over and over, these little creatures will eventually develop resistance," he said in the press release announcing the results. "So we have to think before we use a treatment."

Other Treatments

Luckily for parents everywhere, it is possible to get rid of lice without these insecticide lotions.

An insecticide in pill or lotion form, the anti-parasite drugivermectin, sold under the brand name Stromectol or Sklice, is relatively new (the FDA approved it in 2012) and requires a prescription. Several lotions with stronger insecticides are also only available with a prescription, but are more expensive than the ones with permethrin and some have dangerous side effects that make them not suitable for use on children.

That being said, using more chemicals on a pest normally makes it evolve even more resistance, so these treatments are best used as a last resort.

Some parents use home remedies, like the application of mayonnaise or Vaseline to the head in order to suffocate the lice. But, according to the Mayo Clinic, there is little to no clinical evidence to show that they work.

In the end, many families may need to go back to the tried-and-true standby: Nit combing. A recent study in the journal Parasitology Research, suggests that in about half of cases, combing can be an effective treatment for head lice.

"Combing works," Claire McCarthy, a pediatrician Boston Children's Hospital, said in a Harvard Health Blog about lice treatment with ivermectin in 2012. "It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it's completely nontoxic and without side effects. That can't be said of any other treatment for head lice, ivermectin included."

"Combing works," Claire McCarthy, a pediatrician Boston Children's Hospital, said in a Harvard Health Blog about lice treatment with ivermectin in 2012. "It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it's completely nontoxic and without side effects. That can't be said of any other treatment for head lice, ivermectin included."

Itchy and scratchy – why the battle against head lice just got serious

Nits and lice don’t just infest children and getting rid of them can be hard work – especially with their growing resistance to pesticides. Now a whole new industry is growing up to offer hi-tech solutions to this itchy problem.

This article will make you itch. I’m sorry. There’s no way round it. I’m pretty itchy myself, but that’s head lice for you. They warm themselves on Planet Scalp, sifting wisps with their antennae and, as the experts creepily put it, “taking a blood meal”. I have learned to recognize many types of itch since discovering two of the beasts in my hair. Some are a slow, creeping thaw on the head. Others, a fleeting tweak.

Between 8 and 10% of children in the UK are thought to have head lice at any one time and there are an estimated 6-12m cases a year in the US. But lice can also move from adult to adult. You might have hugged a colleague who has caught them from her children. They can ping from the static of a comb. Or maybe you tried on a hat in your lunch break, and a louse moved into its new home. Contrary to popular belief, there is no data to prove that men are less attractive to lice than women. Can you feel that tickle behind your ear yet?

Head lice have been around as long as humans. They have been picked, preserved, from Peruvian mummies, and pried from the teeth of a Roman soldier’s comb. Yet, despite our long acquaintance, humans know little about lice and what makes them tick. (On the bright side, they do know some lousy puns.) “I’ve combed my head obsessively, I’ve applied treatments, and still found only two lice and some unhatched eggs. How am I meant to know if I have caught them all?” As I speak, the colleagues either side of me stop typing. A few minutes later, they start scratching their heads.

If you don’t have lice, you can still catch delusional parasitosis – the mistaken belief that you are infested. One nit-removal professional told me that for weeks after she started her job she dreamed she was being chased by giant lice. They even infest your telecommunications: every time I text the word “love”, my phone autocorrects it to “lice”. Why, after centuries of medical advancement, have humans not found a way to eradicate them? Why are they so good at evading treatment? And is the anti-lice industry really doing all it could to help those of us at the ticklish end of the problem?

Head Lice Treatment: Comb Them Out Instead Of Using Nix, Rid, Or Other Chemicals

Many parents, desperate to get rid of a case of lice crawling around in their child's hair, will dash out to the pharmacy to buy Nix or Rid, the most widely sold lice-control products in an estimated $130 million over-the-counter market.

There’s a reason those chemical products are so popular. The American Academy of Pediatrics and the Centers for Disease Control and Prevention on their websites recommend using those pesticides, as well as even stronger prescription-only products, to get rid of the nasty insects. Says you should physically remove them instead.

“There’s no reason for parents to douse their children’s heads in chemicals,” says Urvashi Rangan, Ph.D., director of consumer safety and sustainability for Consumer Reports. “Physically removing lice, while it seems daunting, is safest for your child’s head.”

The over-the-counter products are losing their fight against lice because studies suggest that most of the bugs in the U.S. have evolved to become genetically resistant to the insecticides found in those products. That includes pyrethrum in shampoos such as Rid and the permethrin in creme rinses such as Nix. Pyrethrum is a naturally occurring pyrethroid extract from the chrysanthemum flower, and permethrin is a synthetic form of that drug. Products with those ingredients have been available to consumers for decades.

A study published in the March 2014 issue of the Journal of Medical Entomology found that 99 percent of the head lice collected by school nurses and professional lice combers in 12 states and three Canadian provinces were genetically resistant to permethrin. “It’s not surprising that we are seeing a resistance to these products,” Rangan says. “That’s what happens with insecticides and pests over time.”

And despite the label claims, pyrethrum and pyrethroid-based products have only a marginal ability to kill the eggs that remain attached to the hair shaft after treatment. “They can’t be relied on to kill all lice eggs,” says Michael Hansen, Ph.D., a senior scientist at Consumer Reports. When the makers of Nix were asked for the evidence to support the claim that Nix “kills lice and their eggs,” a lawyer for the company said its labeling is scrutinized by the Food and Drug Administration, but the content behind it is considered “proprietary and confidential.”

Lice are sesame-seed-size wingless insects that feed on human blood. They don’t transmit disease, but their bites cause intense itching, which can lead to sores and possible secondary infections. Lice can crawl from one head to another in seconds when children touch their heads together during play or when they share combs or hats. The affliction is now second only to the common cold when it comes to conditions that affect elementary-school students in North America. The U.S. has 6 million to 12 million cases a year among children 3 to 11 years old.

So what is a parent to do? First, don’t panic, and don’t be mortified. “Anyone can get lice,” Rangan says, including the parents of the children who bring them home. In the U.S., African-Americans are less likely to get head lice because North American lice can’t get a good grip on the tightly curled oval hair shafts common in African-American hair.

If you get a warning letter that lice have been discovered at your child’s camp or school, inspect your child right away. A female louse (singular for lice) can lay five to six tiny pearl-colored eggs, or nits, a day near the base of a hair shaft, especially behind the ears or at the back of the neck, and before you know it a few generations could be living on your child’s head if you ignore the problem.

But a child with a first case of head lice may not notice anything for four to six weeks. That’s generally how long it takes for the immune system to develop sensitivity to louse saliva. There’s a chance that the itching could be caused by eczema, dandruff, or an allergy. But if it is a case of lice, it will not clear up on its own.

Here’s what Consumer Reports’ experts recommend.

1. Look for live bugs:

Use a metal nit comb—not plastic—that is thin-toothed and finely spaced. Combing your child’s hair with conditioner or another lubricant, such as olive oil (wet-combing), is much better than just looking for the bugs on your child’s head, according to a study in the March 2009 Archives of Dermatology.

German researchers compared the two methods on 304 students, ages 6 to 12. They found that wet- combing identified infestations in 91 percent of the cases, compared with about 29 percent for visual inspections on dry hair. “Wet combing is the only useful method if active infestation has to be ruled out,” researchers wrote.

Make sure you work in bright light; during the summer you can do this outside on a sunny day. Otherwise, use a bright lamp. To wet comb, first coat your child’s hair and scalp with conditioner or another lubricant. Use a wide-tooth comb to separate hair into very small sections. Follow with a metal nit comb—not plastic—that is thin-toothed and finely spaced (you can also use a flea comb, available at most drug stores), concentrating on very small sections closest to the scalp.

After each comb-through, move the section over, wipe the comb on a paper towel, and inspect for lice. Seal the paper towels in a resealable plastic bag and dispose. Remember to clean combs in very hot, soapy water.

2. If you find any lice, comb and comb and comb

Consumer Reports’ experts say the safest method of getting rid of lice is to physically remove the insects and their eggs by combing with a lubricant such as a hair conditioner. “The chemicals on the market don’t kill 100 percent of the eggs, most pose some level of risk, like itchy eyes or chemical burns or seizures, and they are unnecessary in most cases compared with physical removal,” Hansen says. The key, he says, is to continue to comb out your child’s hair every day until no live lice are seen and then every few days for about a month.

A study of two “bug busting” campaigns in the United Kingdom showed that persistence pays off: All lice were eradicated when combing-out treatments were extended from 14 days to 24 days.

3. Skip the chemical products

Over-the-counter chemical treatments have become less effective over the years. As a general rule, younger children have thinner skin, making them more susceptible to chemical absorption, and they are more vulnerable to the side effects of pesticides.

As noted above, over-the-counter chemical treatments such as Rid and Nix ($20 each) have become less and less effective over the years as the bugs have evolved to become more resistant to them. And they are marginal at best when it comes to killing lice eggs. Possible side effects of using them include red, itchy, and inflamed skin or difficulty breathing, which may be problematic for people with asthma. The products shouldn’t be used near cats because felines are especially sensitive to this class of drug.

Prescription treatments come with a range of risks or side effects, and the drugs can be expensive. In 2011 the Food and Drug Administration approved a new drug called spinosad (Natroba), a topical treatment for use in children ages 4 and up, that was found to be more effective in killing lice than permethrin, according to two manufacturer-sponsored studies. And it claims to kill lice eggs. Possible side effects were minimal, including skin and eye redness or irritation. But its long-term safety is still under study, and it costs $280 for 4 ounces.

Other prescriptions include:

Benzyl alcohol (Ulesfia): (About $140 for 7.7 ounces) A topical lotion for children 6 months old and older (the safety for people over 60 is not established). It claims to kill live lice but not their eggs. Possible side effects include skin or eye itching, redness, and irritation.

Citronellyl acetate (Lycelle): (About $190 for 3.4 ounces) A topical gel for children 2 and up and people under age 60. It claims to kill live lice and some eggs, but not all. Possible side effects include skin or eye itching, redness, stinging, irritation, and burning.

Ivermectin (Sklice): (About $300 for 4 ounces) A topical lotion for children 6 months and older and people under age 65. It claims to kill live lice but not their eggs. Possible side effects include conjunctivitis, eye irritation, dandruff, dry skin, and a burning sensation on the skin.

Lindane: (About $120 for 2 ounces) This topical lotion is banned in California, and Consumers Union petitioned the Food and Drug Administration to outlaw this neurotoxic, possibly carcinogenic pesticide as a lice treatment in the early 1980s. But it’s still on the market as a prescription drug for lice despite reports of seizures and even deaths from improper use. And it’s the only lice treatment that carries a black-box warning (the worst kind).

Malathion: ($210, generic, and $255, Ovide, for 2 ounces) A topical lotion for children 6 and older. This drug is flammable, so any source of heat, such as a hair dryer, could cause your child’s hair to go up in flames. Possible side effects include second-degree chemical burns. Accidental contact with eyes can result in a mild form of conjunctivitis.

5. Prevent it from spreading

If your child has head lice, all household members and close contacts should be checked and treated if necessary. Also tell your child’s teacher, who can then advise other parents to check their children’s hair and treat them if necessary.

6. Don’t waste your money on shielding shampoos

Katie’s note: I don’t agree with the header “Don’t waste your money on shielding shampoos”. While Lice Shield and other products may have falsely advertised, other products such as the ones we recommend, have been clinically proven to help prevent head lice. Products just need to be properly tested before making claims.

Parents eager to prevent their children from bringing home lice may be tempted to buy a shampoo or spray called Lice Shield, which claims it can prevent or reduce the risk of getting head lice. But the Federal Trade Commission charged its maker, Lornamead, with false advertising in May.

The products and ads for it claimed that citronella and other essential oils used in the Lice Shield line would “dramatically reduce” the risk of head lice infestations, the FTC said. The company claimed that its products, sold at CVS, Rite Aid, Walgreens, WallMart, and other stores, were “scientifically shown to repel head lice.” But it doesn’t have a well-controlled human clinical study to support that claim.

As a result, Lornamead must shell out $500,000 as part of the settlement and is banned from making any similar claims in the future. “As any parent knows, an outbreak of lice can wreak havoc,” said Jessica Rich, director of the FTC’s Bureau of Consumer Protection. “When marketers say their products can be used to avoid these pests, they’d better make sure they can back up their claims.”

Head Lice Don’t Take Summer Off

Head lice are equal-opportunity parasites and don't mean you or your home are dirty.

Cases spike when school begins or after school breaks, but can spread at summer camp.

Treatment can mean hard work; professional services are available.

If any of my neighbors had seen me ironing my daughter’s mattress while wearing a blue shower cap, they undoubtedly would have thought I was nuts.

But after we found nits lice eggs in my 9-year-old daughter’s hair, I panicked.

I washed her hair in olive oil and vinegar. I put her dirty clothes and linens in large plastic bags and washed them in hot water. I crammed pillows and stuffed animals into the dryer and set it on high heat. And yes, I even ironed her mattress because a friend told me heat kills lice.

I’m embarrassed to say I wore that shower cap too often during the first few days after lice became part of our lives. I didn’t just wear it for ironing; I also used it when I tried to comb the nits out of Emma’s hair after using an over-the-counter lice treatment creme rinse.

None of this was surprising to Dr. Shirley Gordon, a nurse and professor at Christine E. Lynn College of Nursing at Florida Atlantic University. Gordon, director of the Head lice Treatment and Prevention Project, has studied lice since 1996 and is fascinated by the social ramifications.

Lice: what to look for, how to treat it

“On a scale of 1 to 10, you’re a 11.2,” said Gordon, whose research focuses on persistent cases. Some parents, she said, have used kerosene and gasoline to rid their children of lice.

Lice is an equal-opportunity parasite, yet so many myths continue to surround head lice, including the idea that people who get lice are dirty or live in dirty homes, she said.

“I think one of the causes of the transferability of head lice is silence,” Gordon said. “People don’t want to tell other people their family has head lice because of the social stigma and the long-term ramifications. You become known as a lice family. When you clear up the infestation, that stigma doesn’t go away.”

It’s hard to say how many people get lice in the United States. According to the Centers for Disease Control and Prevention, between 6 million and 12 million infestations occur each year among children ages 3 to 11.

But that number is likely low. Lice is not a reportable condition, which means there isn’t good data on how many cases there are, Gordon said. Cases spike, however, during the first few months of school and after winter and spring breaks.

“We see increased cases after children have spent extended periods of time in the community,” she said. Summer camp is also one form of community, she said. Many camps screen for head lice when children arrive; others send letters to parents telling them to check their children for lice before camp starts.

Lice is controversial at every turn, Gordon said, from how children with lice should be treated in school the American Academy of Pediatrics says no healthy child should miss school because of head lice and that schools should abandon no-nit policies to treatment with over-the-counter products, which are pesticides. I was confused and misinformed when my daughter got lice. I was also loath to tell people, but knew I had to. I e-mailed her teacher and told her I believed Emma got lice from a wig she had worn a day earlier for play rehearsal (that’s possible, but unlikely, Gordon said). “The most frequent reaction is anger and disgust, and there is a sense of wanting to know the source of the head lice infestation,” Gordon said.

A few other things to know about lice, she said:

  • Lice don’t jump or fly; they crawl from one person to another.

  • Head lice are treatable (it might take some work) and rarely cause serious health problems.

  • Head lice are usually spread from head-to-head contact, not from sharing brushes, hats or bedding (although that is also possible).

  • Head lice may be on your head, your child’s head or your spouse’s head, but it won’t affect your pets and can’t infect furniture, bedding or pillows.

For days after using the over-the-counter lice treatment, my husband and I diligently combed through my daughter’s hair with a comb designed to remove nits.

This wasn’t easy. The nits attach themselves to the hair with a glue-like substance. I thought I was doing a good job and naively thought we had the infestation under control.

But a week after the treatment, I found a louse. I panicked again, this time because my daughter had spent all day and night with a group of close friends. I immediately sent texts to my friends, apologizing profusely. Then I sought out a professional service, in California – one of many such services nationwide.

Emma watched a movie on a DVD player while our lice technician, separated her hair into sections, methodically combing it and removing nits, sometimes with a pair of tweezers.

The technician, who has been removing lice for five years, admits you need a lot of patience.

“What we have learned in this industry is that there are no shortcuts to removing lice,” said Michelle Aloisio, “the only way to remove it is the long, hard, manual way.”

Gordon recommends using the Shepherd Method to remove lice and nits. The Technician did: after combing Emma’s hair, she divided it into four equal sections. She examined each quadrant in paper-thin sections, one strand of hair at a time. Then she did another check for missed bugs or nits before inspecting my hair. (I said a silent prayer of thanks when she told me I didn’t have lice.)

“Removing all the nits is the toughest part of lice removal,” Aloisio said. “If you don’t get every single nit, they are going to hatch and the whole cycle is going to start all over again.”

Products kill adult lice, but not eggs or babies. Most of Aloisio’s clients go to her after about a month of trying to get rid of lice themselves.

As far as prevention, Aloisio suggests girls wear their hair pulled back in braids or in a bun. “Swinging hair offers a bridge to infestation,” she said.

The technician used a stainless steel comb and showed me the correct technique for pulling it through my daughter’s hair. I’ve been doing that every night since.

She also used a nontoxic lice infestation removal mousse and a mint spray Aloisio says deters lice. While preliminary evidence shows lice are repelled by mint in laboratory settings, Gordon said there are no strong field studies supporting mint as an effective repellent.

Two and a half hours and $210 later, we left the salon with the comb, the mousse, the spray and the hope that we had won the battle.

If your child has lice, Gordon advises screening friends, relatives, neighbors and people your child spends time with. She also recommends checking for lice once a week.

Her final advice to parents? “Take a deep breath. It’s just lice.”

The future of mutating, treatment-resistant head lice is already here

Head lice aren't particularly dangerous, but they are a nuisance -- one that has become such a common part of life with young children that multiple over-the-counter remedies are available to parents.

That very fact has made the increase in prevalence of lice cases since the 1990s -- despite the corresponding increased access to effective treatments -- so puzzling.

A new study that will be presented at the National Meeting & Exposition of the American Chemical Society on Tuesday suggests one reason for the increase: After decades of treatment with anti-pest remedies sold in drugstores across America, head lice are evolving to resist our efforts to snuff them out.

The study found that of the head lice samples collected across 30 states, all but five showed signs of a very high level of resistance to pyrethroids -- the chemicals contained in some of the most common over-the-counter treatments.

"We are the first group to collect lice samples from a large number of populations across the U.S.," said Southern Illinois University at Edwardsville researcher Kyong Yoon. "What we found was that 104 out of the 109 lice populations we tested had high levels of gene mutations, which have been linked to resistance to pyrethroids."

The trio of mutations -- called kdr, for "knock down resistance" -- affects the insect's nervous system and makes them less sensitive to the insecticide chemicals that are found in lice treatments and also in mosquito repellant or fly spray, for example.

In four states, head lice were found to have one, two or three of the mutations. Only one state -- Michigan -- had head lice samples that didn't show any signs of widespread resistance to treatment; Yoon added that the reason for that is unclear.

 In recent decades, pyrethroids have been increasingly used as a pesticide as part of a broader effort to shift away from harsher chemicals like DDT. Pyrethroids resistance has been found, for example, in house flies.

Anecdotal evidence and previous studies have also suggested that head lice were also increasingly becoming resistant. A 1999 study, for example, found evidence of resistance to pyrethroids in the United States in a small sample of kids who had contracted and had been treated for lice multiple times in the past.

The solution, Yoon says, may be to treat lice with other chemicals that are more likely to be available with a prescription.

"If you use a chemical over and over, these little creatures will eventually develop resistance," Yoon added. "So we have to think before we use a treatment. The good news is head lice don't carry disease. They're more a nuisance than anything else."

Scour That Scalp: Some Lice Eggs Linger Before Hatching

Here’s some lousy news for parents of itchy-headed kids: Lice eggs can take 2 weeks to hatch in human hair, making standard 7-day delousing treatments ineffective in some cases. New research shows that if conditions are right, the eggs, called nits, can sit dormant during treatment, only to pop later and reinfest the scalp. A third application may be necessary after 14 days to eliminate any slow-hatching nits, they say.

Lice don’t lay their eggs directly on skin—instead, they deposit nits at the base of hair shafts. The timing of louse hatching on a human head is difficult to track because adult lice lay eggs continuously, obscuring earlier hatches, and the effectiveness of traditional insecticides on eggs is variable. Previous estimates of how long nits remain viable did range up to 14 days, but much of that work dated to the 1920s and 1930s, when researchers reared body lice inside boxes strapped to a person’s arm or ankle. More recent work relies on head lice raised in lab incubators, which are more stable than the wide range of temperatures and cleanliness found on a human scalp.

For a more reliable estimate, medical entomologist Ian Burgess of Insect Research & Development Ltd. in Cambridgeshire, U.K., analyzed data from 20 previous studies of treatments that kill lice through physical means, such as lotions that suffocate the insects, but do not kill eggs. They didn’t include insecticide treatments because lice across the United Kingdom have developed resistance to standard drugs, Burgess says, leading more doctors to try a brute-force approach that does not rely on insecticides.

The data from 1895 patients revealed cases in which technicians found newly hatched louse nymphs on the 14th day after treatment began, even though the second scalp application had occurred 7 days before. “Some [nymphs] had emerged only an hour or two before checking,” Burgess says. To rule out cases where re-infestation from another child had occurred, or where a few adult lice had escaped treatment, he excluded cases with lice that appeared older than the number of days since the last treatment. Nearly two dozen cases remained—enough to verify that a handful of nits can outlast standard treatment protocols, Burgess reports in an upcoming issue of Medical and Veterinary Entomology.

Although the treatments themselves may play a role, a person's scalp temperature is likely to be the most important factor in how long it takes eggs to hatch, Burgess says. Location and hairstyle matters, too: Lice develop faster at warmer temperatures, so they will hatch more quickly when laid on the warm, thick hair at the nape of the neck than on the thinner hair on top and in front of the scalp.

The analysis is the most rigorous yet to quantify louse hatching times, says Rich Pollack, a public health entomologist at Harvard University. “It should be considered by those who are trying to make a management treatment decision,” Pollack says, observing that just a small number of patients are likely to need a third dose.

New oral insecticides may render the question of hatching times moot, Pollack notes. Those drugs, now available by prescription in the United States, are up to 85% effective at killing lice and eggs with one dose, sparing parents from dousing a squirming child's scalp multiple times.