The Art and Science of Nit-Picking

Back in the early 1980s, I was delighted when the elementary school in my town let me know that I had been hired as the school nurse. Not only would I have a new challenge, but after many years of working as a registered nurse in hospitals, I would no longer have to work evenings and nights.

I loved my new job at the school. My charges were, for the most part, healthy, active youngsters who came to me with scraped knees, bloody noses, tummy aches, poison ivy and the like. Soon I had won their hearts with my pain-free technique of splinter removal.

Of course, there were trying days. In our small, enclosed world, colds and viruses spread quickly. During the winter months my tiny office would be inundated with coughing and sneezing children, and I became very busy checking throats, taking temperatures and wiping small noses.

But cold season was nothing compared with the moment when a teacher would stop me in the hall and say, “Susie’s been scratching her head all morning.” At once I would investigate Susie’s dark brown curls to find tiny, silvery nits, soon to become dark brown six-legged creatures.

School policy dictated that I call Susie’s mother to take her home lest she infect her classmates, which she already had. Soon I had a list of more calls to make, my least favorite chore in the world.

I braced myself for the reactions. Some parents were angry, and it would turn into a shoot-the-messenger kind of day. Others felt guilty and were embarrassed — even horrified. I knew how they felt. I had three children myself and had vivid memories of long, dreary nights fine-combing their hair.

When the parents arrived, I had to hand them a long, green form with the grim title: “Instructions to the Parent of a Child Sent Home With Pediculosis.” The steps included washing the child’s hair with a special shampoo, removing all nits with a fine-tooth comb, cleaning all sheets and pillowcases, airing out toys and mattresses, and so on. The list ended with a stern warning: “The school has a nit-free policy — all nits must be gone before the child can return to class.”

As the grim-faced parents arrived, the principal barricaded himself in his office, his sensible reaction to a public relations disaster. Only the children were unperturbed. “I have head lice,” they announced proudly to their classmates as they packed up to go home.

Every September as children returned from summer camps and sleepovers, our school would have an outbreak of lice. I tried to get a head start on the problem. I studied the literature, which was voluminous and overwhelming. There were reams of advice from dermatologists, school nurses, infectious-disease experts: “Be proactive,” “Prevention is the key,” “Screen all the children in the school.” Even the psychologists weighed in. “Avoid alarming the parents,” they warned. I read and read until my head ached.

So on the first days of school, magnifying glass in hand, I scrutinized 300 small heads. I lectured the children: Never share combs, brushes, hats, hair, ribbons, bike helmets. I sent memos to the parents. “You are the first line of defense,” I wrote. “Check your child’s head vigilantly. Be alert to symptoms — investigate at once if your child starts scratching her head.” What I wanted to write but could not was, “Please, please, never send your child to school with full-grown creatures romping through her head,” as one mother once did.

Despite all my efforts, the outbreaks continued unabated. In my own small way I had confirmed the findings of researchers at the American Academy of Pediatrics, who concluded that screening programs do not have a significant impact on the incidence of head lice. Each year the lice grew bolder and more robust, breaking my heart and even confounding Big Pharma as they became resistant to the killer shampoos.

I’m retired now, but I keep a professional eye on what’s happening with the pediculosis establishment. “No-nit policies for return to school should be abandoned,” said the American Academy of Pediatrics in a groundbreaking statement in 2010. The National Pediculosis Societyfired back, militant in its faith in no-nit policies. What’s a parent to do?

 I’ll still be watching the head lice battles from the sidelines, silently cheering all the parents who search in vain through shining tresses for the one that got away.