Most people without young children believe lice are something that afflict the great unwashed.
Parents with kids in elementary school know they're a fact of everyday life. An estimated 6 million to 12 million children a year have infestations, according to the American Academy of Pediatrics. The tiny insects, some no bigger than the head of a pin, feed on blood from the scalp.
And they don't disappear in the summer.
Leslie Morgan Steiner, editor of the 2006 book Mommy Wars, found out that her daughter had lice at Disney World. For a special treat, she had taken her daughter to the Bibbidi Bobbidi Boutique for a princess makeover. After the girl had been in the chair for just a few minutes, the manager took Steiner aside to a private dressing room and asked in a quiet voice "if I'd ever heard of animal parasites," Steiner says.
When what Steiner was being told finally sank in, the manager "put her hand on my arm and said, 'It's OK, this happens all the time. But you have to leave. Right now.' "
Steiner went straight to a drugstore and spent the rest of the vacation giving the family delousing shampoos and picking lice eggs, or nits. She thinks her daughter picked up the unwanted hitchhikers at day camp.
Sleep-away camps are especially paranoid, with a significant percentage turning kids away if they arrive infected. "I'm seeing camps telling parents to check their kids for lice before they come," says Linda Erceg, executive director of the Association of Camp Nurses in Bemidji, Minn.
A survey of camp directors by Fairy Tales Hair Care, which makes lice-busting hair products, found that 24% of camp directors reported an outbreak last year, but that close to 40% of sleep-away camps don't check for lice when campers arrive.
Katie Shepherd of Lice Solutions Resource Network in West Palm Beach, Fla., spends much of the summer in New Hampshire going from camp to camp with her staff, doing nit-picking and lice checks. "One of the camps I was at had 250 arriving campers. We found, on Day One, 21 cases of lice. These are kids who are going to spend four weeks together; they're together 24/7."
Head lice have nothing to do with cleanliness or housekeeping, says Barbara Frankowski, a pediatrician at the Vermont Children's Hospital in Burlington.
Lice have always been with humans; we evolved together. They're spread by head-to-head contact. When kids read books together or play or do anything that causes their hair and heads to touch, lice can be transmitted. What lice can't do is fly, jump or live more than a few hours off their human hosts, she says.
"It doesn't mean you're a bad parent," says Frankowski, who wrote guidance on lice for the American Academy of Pediatrics. Head lice carry no diseases and are really only a nuisance, not a health risk.
Nits or no
Nationwide, a furious debate over whether schools and camps should follow "no nits" or "no live bugs" policies is slowly being won by the "no live bug" side.
No-nit policies require that no children with lice eggs in their hair should be allowed in school or camp. It's pushed most strongly by a growing number of businesses, both for-profit and not-for-profit, which provide professional lice removal services (i.e. nit-picking) in salons and homes.
On the "no live bugs" side, which requires that only kids with actual lice be kept out of school while being treated, are the American Academy of Pediatrics and the National Association of School Nurses.
Part of the push to end no-nit policies is that even lice-killing treatments still leave nits in the hair and kids are missing a lot of school. One study found that 12 million to 24 million school days are lost each year because of children being sent home from school because of nits.
With six kids and both parents working, Angelo Jimenez of West Palm Beach experienced this firsthand. When lice hit his family this spring, he shaved his boys' heads, but the three girls, each with long hair, were more than he and his wife could handle. "In the elementary school, they were sending kids home left and right. It was ridiculous. I said, 'My kids have missed too much school.' "
Finally he took them to Lice Solutions Resource Network. It took five hours for the specialists to go through his three daughters' hair, he says. "They literally take it strand by strand," he says. "We were so grateful to them."
Karen Franco, who runs Advice on Lice, a lice treatment service in Kensington, Md., says, "There's no way to avoid the manual removal." For most cases, it takes between an hour and an hour and a half. "Our record for worst-case infestations was four."
But it doesn't necessarily require a professional, just time and patience. Nit-picking and fine-tooth-combing are skills that get better with practice, says Diana Dembeck, a banker in San Francisco. After two bouts of lice with her third-grade daughter, she got so good at it that she's on her school's Lice Squad. Two moms together can check 20 to 40 kids in a morning.
As she works, Dembeck talks to the kids, making sure they know that lice are no big deal, how braiding or tying back long hair helps and mostly calming everyone down.
Resistance is futile
Lice live only on human hair. The female louse, about the size of a sesame seed, lays approximately 10 eggs a day and glues them to the hair shaft. They hatch in 10 to 14 days. Lice can live for three to four weeks.
The American Academy of Pediatrics recommends using over-the-counter insecticidal treatments, which kill lice but not eggs, when an outbreak is discovered. Then nine days later, a second treatment is done, to catch any nits that may have hatched in the meantime.
For parents who feel uncomfortable with using chemicals, manually picking out lice and nits also works. The work requires nothing more than good light, a metal-toothed comb and patience. "Everybody wants an easy answer, but no matter what you do, you have to get the nits," says Frankowski.
For those who choose not to do it themselves, salons providing the service, at $50 to $100 an hour, are springing up across the country.
Schools are not always as educated as parents wish them to be. When Shannon Weber, a nurse, talked to the nurse at her son's school about a bout of lice, she was asked, "What dogs has your son been playing with?" Lice only live on humans, Weber explained.
In an attempt to shield children from ridicule, schools sometimes are too discreet about outbreaks, she says. It was only when the third wave of lice hit her children's school that the principal finally sent out notes.
But the kids were actually quite matter-of-fact and fine with it. It was the adults who had problems, she says.
That could be because lice can become a family affair, to parents and siblings. Experts recommend washing the sheets and pillowcases from the infected person's bed in hot water. Vacuum areas that come into direct contact with the child's head, such as sofa backs and cushions and car seats.
But the first thing for parents to do when their kids come home with lice is to "give them a hug and make sure they understand they haven't done anything wrong," says Richard Pollack, an entomologist with the Harvard School of Public Health.
"A kid who doesn't have friends doesn't have lice."
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