A Real Head Scratcher
Schools are struggling with how best to handle lice
Two weeks ago, parents of 26 children at Candler Elementary in North Carolina got the dreaded call: Lice! Come get your child, and keep him home until every last egg, or nit, is gone. At Chabot Elementary School in Oakland, Calif., meanwhile, even children with live lice will no longer miss any class. Parents will be discreetly informed at the end of the day so the lice can be wiped out overnight; nits are not an issue. Nora Cody is thrilled. "Last spring, I was called out of a meeting 10 minutes after school started because my child had nits," says Cody, the mom of a then fourth grader. "It turns out it was just a bit of fluff."
What's the right way for schools to cope with lice? It's a question on the agenda of many a board these days. The time-honored approach-not a single nit allowed-has created a dilemma in the No Child Left Behind era; many states use attendance rates as a measure of school performance, and lice outbreaks are thought to account for 12 million to 24 million missed days a year. In 2002, the American Academy of Pediatrics proclaimed that "no nit" policies are overkill, since the vast majority of kids with only nits will not end up with lice. Los Angeles; Madison, Wis.; and Allentown, Pa., are among a growing number of districts that, like Oakland, are relaxing the rules. Other administrators are standing firm-and lots of parents approve. "I think the policy is great," says Karin Von Dohlen, one of the Candler moms recently called in. "You want to nip it in the bud." She spent hours of the unexpected day off removing nits from 7-year-old Sarah's head so she could go back to school the next day.
No bugs. Nobody disputes that the live lice have got to go. The tiny blood-sucking creatures, no bigger than this t, don't cause any health problems other than itchy bites, but they spread easily by crawling onto any hair strand within reach. Research has shown that 9- and 10-year-old girls, who favor group hugs, are the most likely to get infested. If she's not stopped, a female louse can lay more than 100 nits on a child's head over her 30-day life span, dozens of which will hatch about 10 days later.
But opinions diverge on what should happen once the bugs themselves are gone. While nits stick tightly to the hair shaft and don't spread from child to child, most survive the over-the-counter treatments-and can hatch, starting the cycle again. The AAP guidelines, which call for monitoring children with nits, "are bizarre," argues lice expert Craig Burkhart, a dermatologist at the Medical University of Ohio and author of a dozen studies on the bugs. He's concerned about recurrent outbreaks, given that lice are rapidly growing resistant to existing treatments. But a 2001 study conducted by researchers at the Centers for Disease Control and Prevention-the basis for the AAP recommendation-found that more than 80 percent of kids who have only nits never become reinfested.
"A lot of kids are missing a lot of school," says Barbara Frankowski, chair of the AAP Council on School Health and coauthor of the AAP guidelines; some, the guidelines note, are forced to repeat a grade. Even those who have adopted the AAP position say that what's best for the school population might not be best for an individual child. To keep a child lice free, parents should remove all nits within one-fourth inch of the scalp, cautions Stan Husted, the California Department of Health Services official who wrote guidelines this year advising districts in the state to drop their no-nit policies in favor of "no lice" rules. Nits farther away from the scalp are dead or already hatched.
Partly, what prompts administrators to be more lenient is the realization that outlawing every nit often leads to overdiagnosis and overtreatment. One influential study by researchers at the Harvard School of Public Health analyzed 614 suspected lice samples provided by head-checkers in schools and elsewhere and found that only 364 contained a louse or nit. The rest were other bugs, dandruff, scabs, or dirt. "We found that lice aren't as prevalent as we once thought. Maybe 1 in 100 kids has it at any given time," says lead study author Richard Pollack.
The surest way to stay out of that select group is to avoid any head-to-head contact. (Not sharing hats, combs, and jackets is also a smart idea, although lice that are shed onto a surface other than a human head won't live for more than a day or two.) Treatment, should the worst happen, can be downright aggravating. Over-the-counter products like the cream rinse Nix and the shampoo Rid were highly effective against lice and nits 20 years ago. Numerous experiments have shown that their active ingredients have lost power as lice have adapted, according to a 2004 literature review published in the Mayo Clinic Proceedings. Still, the AAP recommends using a cream rinse containing 1 percent permethrin (Nix and generic versions) as the first line of treatment. For the moment, lice seem to be more resistant to the pyrethrin products (Rid and generic versions), says Frankowski.
Aftermath. After drenching hair with either product, purists spend hours scouring the child's hair for every remaining nit, checking and rechecking for days. Instead, says the AAP, you can repeat the treatment in a week. If the product is effective, it should kill any new baby lice before they lay eggs. Most experts agree that a top-to-bottom house cleaning is unnecessary. But it's smart to wash the child's bedding, towels, and clothes worn in the previous 24 hours and to vacuum areas his or her head has touched.
If any bugs survive the initial treatment, a more powerful nuking may be called for. Ovide, a prescription lotion containing malathion, is the strongest weapon in the arsenal, shown to kill 100 percent of lice and 98 percent of nits. But it has disadvantages: Its odor can cause headaches and nausea, and it is flammable. Ovide stays on the head for eight to 12 hours, and the child needs to steer clear of space heaters, grills, cigarettes, and anything else that could ignite a flame.
Reluctant to use pesticides-sometimes repeatedly-on their kids, many parents turn to alternative products. Some, for example, rub tea tree oil or rosemary oil on their child's head in an effort to prevent lice, but scant research has been done on these oils, and they can sting and burn the skin and cause hives in those who are allergic, according to the National Capital Poison Center.
Other home remedies might be worth a shot, says Burkhart. Two years ago, dermatologist Dale Pearlman published a letter in the journal Pediatrics reporting a 96 percent success rate using a nontoxic lotion that he called "Nuvo" to kill lice by suffocating them. The lotion-which he later admitted was Cetaphil skin cleanser, rebottled "with a nozzle-type cap to facilitate delivery to the scalp"-is applied to the head, dried on with a blow-dryer, and left for eight hours. Smearing a child's head with Vaseline, mayonnaise, or olive oil can also work to suffocate lice, though none is even close to 100 percent effective. "I've found about half of lice die, and it's somewhat easier to comb the living bugs out after treatment since they're immobilized," says Burkhart, who has studied these remedies. Be aware that such nontoxic substances will not kill nits.
A new hair gel treatment you may soon hear about at school is Licefreee!-part of a lice education kit recently sent out by the National PTA to 32,000 PTA chairs. Licefreee! uses a salt solution to kill lice. That salt might dehydrate lice doesn't surprise Frankowski, though she questions how effective it could be at killing nits. Steve Smith, chief executive of Tec Laboratories, which makes Licefreee! (and is a corporate sponsor of the PTA), says research conducted by his company found that it kills 100 percent of lice and nits. He adds that sales for the product are up 25 percent since the mailing.
Some families who can't defeat lice on their own are taking advantage of a new mini-industry: the professional nit-picker. "Most people have gone through three products and hundreds of dollars before coming to us," says Maria Botham, who started Hair Fairies, a lice treatment salon with locations in New York and Los Angeles, eight years ago after reading a newspaper article that suggested a need for such services. Children are entertained by Game Boys and DVD players while trained professionals shampoo and pick through their hair. The average cost? About $330 for the three appointments it typically takes to get the job done.
This story appears in the October 2, 2006 print edition of U.S. News & World Report.