“Head Case: The survivors guide to lice (we hope you never need it)”

head case

The survivor’s guide to lice. (We hope you never need it.)

by Nancy Pick photographs by JJ Sulin

If you discover that your child has lice, here’s what I’d recommend. Scream. Just scream and get it over with.

And then, perhaps, you can learn from my mistakes.

Last summer, my 12-year-old son Jacob came back from sleepaway camp with lice. I knew what to look for—the eggs, tiny white specks, glued to the hair shaft—because he’d had lice before, when he was 6.

I headed straight to the pharmacy. Last time I’d used Rid, a lice-killing shampoo. Jacob had a mild case back then, and a single shampooing did the trick, though I still had to remove the eggs, or nits. But I didn’t feel great about applying an insecticide, the stuff I avoid putting on my lawn, to my child’s head. Moreover, I knew that some lice have become resistant to pyrethrins, the neurotoxins derived from chrysanthemum plants that are the product’s active ingredient.

So this time I decided (with a gulp) to try a nontoxic treatment called Licefreee (yes, three e’s), which is essentially gelled salt. The gel immobilizes the lice so the salt can go to work dehydrating the adults and eggs.

After leaving the treatment on Jacob’s head for an hour, covered by a shower cap, Licefreee seemed to have killed all the adults.

Now I had to comb them out. The package comes with a metal nit comb that worked better than my old !

plastic one. When I first combed Jacob’s hair, little

I didn’t feel great about applying an insecticide to my child’s head.

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September 2008

Hair by Livio Angileri for Kérastase Paris at Ford Artists

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the

411 on lice

For up-to-date information on lice, including pictures, go to cdc.gov/lice.

Myth: brown insects fell into the sink. Sesame seeds with

My stomach sank. Maybe dandruff, I thought. With

of Pediatrics, between 6 million and 12 million

2006 for use in agriculture. So although I can no longer

Americans (most under age 12) get head lice per year.

spray lindane on my corn field, I can still get a doctor’s

legs. Worse, some were bloody. That’s because the

lice, there are endless opportunities for denial. Milo

human head louse, Pediculus humanus capitis, dines

had a horrible case. Hundreds of nits. (Scream louder.)

on only one food: human blood. (Scream again.)

I’d gotten rid of the lice on one son, only to let them

nurse examined his hair under a huge magnifying

to an FDA health advisory, its neurological side effects “have ranged from dizziness to seizures.”

Still, even with conscientious combing, some nits

Five days after we first found Milo’s lice, the school

spread to the other! I’d stopped checking Milo’s head

glass, declared him lice free, and let him back in school.

remained. We combed and combed, twice a day.

far too soon. And worse, now they were all over the

I drove home and drank a glass of vodka, straight up.

We washed all his clothes, rolled up his bedroom rug,

house. I had lice. Even my husband had a mild case.

vacuumed, and changed his pillowcase daily. We had

I stocked up on Licefreee. I stripped all the beds and

my chemical romance

prescription to shampoo it into my son’s hair. According

washed all the sheets. I washed everyone’s clothes. My

Twenty years ago, clinical trials showed that nearly 100

Abigail Rosenfeld, a professional nitpicker extraordi-

husband and I stuffed all our couch cushions, pillows,

percent of adult and juvenile lice were killed by sham-

naire who was profiled in The New Yorker several

I understood from my online research that head

and comforters into garbage bags, where they would

pooing with permethrin (in Nix) and pyrethrins (in Rid).

years ago as “The Lice Lady.” Rosenfeld, who lives in

lice can only live on the human head. That’s where

remain for two weeks, until the lice were dead. (Lice

they eat, mate, and lay their eggs. If we could comb

live no more than two days away from the human

gotten tougher. Technically speaking, it’s incorrect to

friends when she was 13, sums up her simple method

out young lice before they could mate—lice do not

head, but the nits can take up to 10 days to hatch.)

say that the insecticides have caused lice to toughen

this way: Pour on a white conditioner (which immobi-

up. Rather, some lice randomly mutate in a way that

lizes the lice and makes them easier to see) mixed

Reality: Insects don’t pay attention to household income levels.

Brooklyn and started picking nits for her family and

Myth:

reach sexual maturity until they are at least 9 to 12

And then I had to make those awful phone calls.

days old—then we would ultimately win the battle.

We’d had three families over for dinner the night

provides resistance to insecticides, and the mutants

with a little baking soda (which acts as an abrasive to

After a week, the last signs of Jacob’s lice were

before. I had to call all of them with the, er, lousy

are the ones that survive, says John Clark, a professor

strip out the eggs) and comb out the lice using a high-

gone, though we continued to check his head. I felt

news. I had to call the school, whose administrator

of toxicology who studies lice at the University of

quality metal nit comb. Keep combing for a week or so.

triumphant. But I had made a terrible error.

said Milo would have to stay home until every last nit

Massachusetts in Amherst. “If one of these mutations

Rosenfeld offered to share her technique because

was gone. Unlike New York City public schools, which

leads to insensitivity so that the compound no longer

she is a kind person, someone who radiates compas-

was eating lunch at a Chinese restaurant when he

last fall began allowing children with nits (but not

kills the individual,” he says, “then that individual

sion, exactly the woman you’d want to go to if your

started scratching. “My head has been really itchy

active adult lice) to remain in school, my son’s school

becomes resistant. It survives, reproduces, and then

head or your child’s were crawling with insects. Quite

lately,” he announced.

in Deerfield, Massachusetts, upholds a zero-tolerance

that mutation is basically fixed in the population.”

simply, she loves children. Rosenfeld, an Orthodox

policy. Luckily I work from home.

Survival of the fittest.

Jew, has 13 of them. Her youngest is 2, and her oldest,

Worst of all, I had to break the news to Milo’s

The truth is that when I used an insecticide the first

Lice like to live in clean hair too.

Only low-income families get lice.

Fortunately, there’s a better way, as demonstrated by

cule baby. Newly hatched. With tiny legs. (Tiny scream.)

Fast-forward two months. My 8-year-old son Milo

Reality:

Myth:

the head nitpicker

occasional setbacks, whenever we combed out a minus-

Since then, however, lice have evolved. They’ve

Only kids with dirty hair get lice.

Lice jump and fly.

Myth: Lice spread from a shared comb or hat.

at 22, is married with a child of her own.

friend’s mother, who is a clean freak. She reacted by

time, I was helping select for a stronger louse. Any

spraying antilice insecticides all over her house. (This

lice that survived my son’s treatment may have had a

a bug that’s no worse than an inconvenience and an

you should not do. Whatever your attitude toward

mutation that made them harder to kill the next time.

embarrassment. “Some people struggle with lice for

Reality: Neither is true. They spread through head-tohead contact.

Reality: Contagion via indirect contact is rare. A healthy louse stays on a healthy head.

Using insecticides is overkill, Rosenfeld says, for

So doctors and pharmaceutical companies have

weeks because they don’t get the nits out. They only

site says: “Spraying the house is NOT recommended.

been looking for different insecticides to fight these

use the shampoos.” Regular combing is essential. (For

Fumigants and room sprays can be toxic if inhaled or

tougher lice. Ovide, available only by prescription,

amateur nitpickers like you and me, it does help to

Myth:

absorbed through the skin.”) Not surprisingly, the

contains malathion, considered a relatively safe

start with a product like Licefreee.)

Lice transmit disease.

antilice shampoos, the Centers for Disease Control web-

friendship has been strained ever since.

insecticide. Malathion was sprayed over New York City

Reality: Head lice might make you sick but they don’t make you sick.

Rosenfeld’s clients are rich and poor and everything

Still, I understand why she sprayed. Lice

in 1999 during an outbreak of the mosquito-borne

in between. They come from nearby public schools

carry a stigma. They’re embarrassing.

virus that causes St. Louis encephalitis, but as a lice

in Brooklyn and from fancy Manhattan private schools.

treatment it has not been tested on children under 6.

They drive to her from Westchester suburbs, New

Also, it needs to be left on the head for 8 to 10 hours,

Jersey, Connecticut, even as far away as Boston. When

which can be uncomfortable. And there is evidence

I visited Rosenfeld, Mara from New Jersey was missing

Myth:

of lice developing resistance to malathion. “Lots of

third grade because her mother had found lice in her

insects have become resistant to malathion,” Clark

daughter’s hair. First thing the next morning they drove

Prominent poets wrote odes to lice.

says, “and there’s no reason to think that lice won’t.”

an hour to Rosenfeld’s house. Although Miriam, Mara’s

They make you feel unclean. Even though lice do not care whether you’re dirty or clean, rich or poor. According to the American Academy

A last-resort prescription option is lindane, the active

mother, had used an antilice shampoo on her daughter’s hair the night before, it still contained hundreds

banned by the Environmental Protection Agency in

of lice in all stages of development, all perfectly lively.

!

ingredient in Kwell antilice shampoo. Lindane was

Reality: This one’s true: Rimbaud, Burns, and the haiku – all did. poet Basho

With lice, there are endless opportunities for denial.

Has your family been infested with lice? Share your pain (and solutions) on wondertime.com.

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The Lice Survival Kit Metal nit comb comb out very short hair or a mild case in as little

laundry cycles are perfectly adequate, Rosenfeld says,

as 15 minutes, but Mara’s kinky hair required two

as long as you keep combing. “Concentrate on the

hours of steady work. Rosenfeld poured a blob of

head, not the house,” she says. (The CDC agrees:

the conditioner/baking soda goop into Mara’s hair.

“Head lice do not survive long if they fall off a person

Then, using a German-made stainless steel nit comb

and cannot feed. You don’t need to spend a lot

called the Nisska, she combed through sections

of time or money on housecleaning activities.”)

of Mara’s hair, moving up and away from the scalp, often wiping the comb on a paper towel.

Mara had a bad case, and the paper towels

Miriam says she was happy with the results. “Abby removed pretty much all of the lice and nits, educated us on what to do at home, and most importantly,

revealed a thriving insect society of adults, nymphs

gave me the confidence and tools to continue the

(young lice), and nits. Examining the paper towel,

difficult treatment of Mara's hair myself.”

the 8-year-old said, “It looks like yogurt with little pieces of chocolate in it!”

It turned out that Mara’s mother had lice too,

salad dressing solutions?

What about home remedies? A recent Journal of

though they were hard to spot in her straight gray

Pediatric Nursing study of six common ones showed

hair. After about a half hour she was declared

that petroleum jelly worked best, asphyxiating about

clean. Rosenfeld charges $200 for a mother-daughter

62 percent of lice within eight hours; it also allowed

treatment like this, including the Nisska comb

only 6 percent of the eggs to hatch. Olive oil and

that Miriam took home. She instructed Miriam to

mayonnaise lowered hatching rates by smothering the

keep combing out her own hair and Mara’s every

eggs, which the researchers submerged for 9 to 10

other day for at least a week.

days (my sons would have objected). Neither vinegar,

She also gave Miriam cleaning and bagging instructions for bedding, clothes, even stuffed animals that

melted butter, nor isopropyl alcohol killed lice or prevented nits from hatching.

Abigail Rosenfeld recommends the Nisska, $24, at exit15.com/nisska combs-p-1581.html.

Her second choice is the LiceMeister, $10, at headlice.org/catalog.

Other studies reported that a compound found Download a shopping list and step-by-step lice removal instructions at wondertime.com.

might have touched her daughter’s head. Regular

Louse photograph by Dorling Kindersley/Getty Images

Mara’s hair was a real challenge. Rosenfeld can

in several plants, including tea, cardamom, and thyme worked best against nits. Oil derived from cinnamon bark also proved effective in killing both adult lice and nits. But these are compounds isolated in laboratories, not commercial products; there’s a good chance that whatever I buy won’t be the same strength, freshness, or purity.

Nontoxic “shampoos”

And even if it does work, here’s the rub: If we all

Get Licefreee and other nontoxic lice treatments at drugstores for around $20.

use cinnamon bark or other essential oils against lice, the lice will almost certainly develop resistance to these too. “A natural product is nothing more than a chemical that has been made by a plant,” says Clark.

Conditioner

“So it’s still chemical control. And any time you use a

Get one that’s thick and white, such as Pantene Pro-V Conditioner, Smooth & Sleek, $8.

drug to control an organism, you’re opening the door for resistance to occur.”

Lice are a challenge. They put to the test all my beliefs about cleanliness, serenity, hairstyles, work,

Baking soda

school attendance, public health, insecticides, and

Rosenfeld mixes this with the conditioner to help strip out the nits.

insect evolution.

In the end, I am left with the hands-on approach.

I fervently hope that my children never get another

Natural or bright light

bout of lice. But for now, I’ll hold on to my nit comb.

Bathrooms typically have the best light but additional light sources can be useful.

I’d rather do a little manual labor than contribute to the building of a better louse.

Large trash bags Get lots of these to hold contaminated clothing and bedding.

White paper towels To catch—and see— what you comb out.

It’s both disgusting and satisfying.

Magnifying glass or loupe Particularly useful if you don’t have sharp eyes.

I’d rather do a little manual labor than contribute to the building of a better louse.

Nancy Pick (yes, that’s her real name) with Milo (left) and Jacob (right) modeling the ultimate defense against head lice: no hair.

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