A Louse in the House?

Stay Calm and Start Nit Picking

By Lauren Katims

Head lice. The words alone make people shudder.

Berit Pratt, co-founder of NitWits, a professional lice and nit-picking service in Cambridge, MA, says mothers call her in tears, frustrated and stressed out over bugs that won’t go away after multiple attempts with different treatments. “Mom Lice Stress” is what Pratt and her two nit-picking colleagues call it.

If you panic and don’t know how to handle a lice situation, “it can take a toll on the family for weeks,” says a mother of three from Needham who asked not to be unidentified. Her three daughters had head lice at the same time twice last year. She would spend six hours a day checking and picking nits, only to wake up and find more in the morning.

With all the panic and frustration over head lice, one might think these clingy critters are a dangerous health threat. But all this fear and panic is more the result of ignorance, experts say.

“Head lice create a heightened anxiety in not only parents, but in teachers as well,” says Arlene Swan- Mahoney, assistant director for Boston Public School Health Services. “We try to educate families. … We reassure them there is no danger.”

Why the Bad Reputation?

“Misconceptions and misperceptions about head lice abound,” says Richard Pollack, an entomologist from the Harvard School of Public Health. “People equate head lice with other kinds of body lice and health problems. They need to understand that head lice are at most a minor nuisance – not known to transmit any illnesses, not a sign of poor parenting, poor hygiene or poor housekeeping.”

He imagines that people compare a head lice-infested child to Pig Pen from Charlie Brown – shedding dirt and bugs wherever the child goes. That is not the case. Head lice (or pediculosis) are tiny, wingless bugs about the size of a sesame seed that range in color from brown to gray. They are crawling insects – they cannot hop, jump or fly. In fact, a louse (singular for lice) rarely falls off the hair shaft. Lice have been around for more than 2,000 years, discovered on ancient mummies, and are considered an extremely resilient species. They can live only on the human scalp and have six legs and tiny claws that allow them to grasp hair shafts.

Humans can harbor three different kinds of lice – head, body and pubic – and when people get those confused, stigmas arise, says Pratt, who doubles as a school nurse. Body lice thrive where people live in crowded, squalid conditions. These lice carry Epidemic Typhus (a bacteria called Rickettsia prowazekii), which killed Anne Frank, 10 million people in Russia in 1914 and thousands of soldiers in World War I. Head lice and pubic lice, on the other hand, do not carry disease. Pubiclice are sexually transmitted and found in post-pubescent humans, not elementary school-age children.

Because of the confusion between head lice and body lice, people mistakenly think that if their child has head lice they need to vacuum the house and do copious amounts of laundry. This would be appropriate for body lice, which live off the human body in clothing and bedding. However, no vacuuming, laundering or bagging of items is necessary with head lice. Head lice and their eggs (nits) live exclusively on the human scalp. They are very temperature-and humiditysensitive, and are unable to feed, travel or survive once off a human scalp.

In fact, a head louse isn’t harmful at all. For proof, Pollack tried to culture the insect in a plastic container on his arm. “I know what it feels like, and I didn’t lose a minute of sleep,” he says.

Head lice are usually passed from direct head-to-head contact. It’s possible to contract lice from personal items such as combs, hats and towels, but it’s not likely, experts say. A louse can survive 24-36 hours, at best, without a host. Furthermore, any louse that falls off a human and is sick or dead will not likely reattach itself.

Putting the Issue in Context

The National Association of School Nurses reports there are six million cases of head lice in the United States each year. But Pollack calls that figure a gross exaggeration. The numbers, he says, are based on treatment product sales, and many people self-diagnose themselves with head lice when they actually have dandruff.

Still, the problem affects enough of us to warrant avid searches for information. The National Pediculosis Association’s (NPA) Web site ( averages 25,000 hits a day.

Fifteen years ago, professional nit-picker Helen Hadley got head lice when her daughter became infested after summer camp. Hadley, a former book designer and artist, struggled to get rid of the lice for eight weeks. After finally clearing the critters from her home, she decided to use her artistic hands to start her own nit-picking business. Now, she travels from her Needham, MA, office to homes around New England to treat thousands of head lice cases by hand-picking the nits – or lice eggs – off heads.

Although there is no lice season, Hadley says she sees the most cases during the back-to-school months of September and October. Children participating in high-contact activities at summer camps, especially sharing cabins at overnight camps, are more susceptible to getting lice. The cases are often then diagnosed by school nurses when the kids return to class in the fall.

Hadley says that the frequency and severity of cases she’s seen have increased in the past few years. These days, she gets 30 calls a day and can spend half a day dealing with nits at just one home. That has left her and her two partners burnt out and behind schedule. One parent customer even tried to bribe her with an extra $300 to get to the top of the waiting list. Hadley declined the offer.

Who is Susceptible?

To a louse, everyone is fair game. Pollack studied 10,000 elementary-aged children in six states and found head lice in every community. “In some schools, we might find an infestation, and in a school down the block, there could be none. Two weeks later, the numbers could be completely different,” he says.

Cases do tend to show up in girls more frequently, says Pollack, because girls tend to have longer hair and are more affectionate with each other, sharing iPods, reading, brushing each other’s hair – all activities more likely to induce head-to-head contact. But Hadley says that in the last two years, she’s seen an increase in the number of boys’ cases, which she attributes to longer hair styles and sharing athletic equipment such as baseball caps and batting helmets.

Lice tend to show up in children ages 3 to 12, when kids begin to more closely interact with their peers. Pollack has seen cases in high school students (usually attributable to a younger sibling) and senior citizens (attributable to a grandchild).

“If anything,” Pollack notes, “head lice would be a sign that the child is social. If you don’t have any friends, you aren’t very likely to have head lice.”

Exterminating the Bugs

A number of lice treatments are on the market. Debate continues over the safety and effectiveness of one such treatment, chemical shampoos. According to the NPA, research has shown that lice are becoming increasingly resilient to permethrin- and pyrethrin-based shampoos, which are widely used as over-counter treatments. There are stronger prescription shampoos available, but these concern health officials.

The Massachusetts Department of Public Health warns that “the chemicals used to kill head lice and their nits may be toxic and should be used with care, under the supervision of a health care provider.”

Pollack argues that if used correctly, the shampoos are not likely to cause any problems, and the benefits outweigh the risks. But Hadley and Pratt don’t recommend using them at all.

In response, many people have turned to homemade remedies. Hadley suggests a quarter of a cup of olive oil, three times a week for eight hours. Before bed, carefully apply the oil to your child’s hair in sections, similar to the way you would get your hair colored at a salon, she says. Then put a clean towel on your child’s pillow. In the morning, wash the hair thoroughly and comb through the sections. You can also try this method with a hair conditioner or Cetaphil Gentle Skin Cleanser.

Whichever treatment you use, you can’t escape the task of physically picking the nits off the hair. Having a fluorescent light with a magnifying glass eases this process.

“You have to put in the time,” says Hadley. “In this culture, we are used to having a quick fix to something – a pill, a doctor’s prescription – there is nothing like that for this.”

Most importantly, reminds that Needham mom of three, “I know it’s embarrassing and it’s gross, but you have to take responsibility.” It’s a much worse feeling to know that your kids have passed it on to someone else’s kids because you didn’t deal with it yourself, she says.