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The most important school supply that's not on your child's list
It's not just children who go back to school in the fall; they're often accompanied by head lice, the tiny parasite that bedevils many families with young children. Here are strategies to help lice-proof your household. - photo by Jennifer Graham
It started with an itch. It ended with a long soak in some nasty smelling shampoo.

At least thats how an episode of head lice used to play out, before the wily parasite figured out how to outsmart conventional treatments. Now, as schools open across the country in the warm weather that lice love, parents are fretting about super lice that survive over-the-counter treatments, while businesses offer to come to the homes of the afflicted to discreetly nit-pick.

But there are things parents can do to reduce the risk of your child coming home from school with a tell-tale itch.

For starters, buy a lice comb, even if your children have never had lice, one lice-removal expert says.

Every family with school-age children should own a quality lice comb and use it at least once a week, says Katie Shepherd, founder of Lice Solutions, a nonprofit education and removal salon based in Florida, and its research arm, The Shepherd Institution.

If you do that, you will always catch that case before it has a chance to escalate or spread," she said.

A lice comb, Shepherd said, should be on the school-supply list of every school in the country. But that's not all parents should know.

The rise of super lice

Head lice are one of three kinds of lice that can live on the human body; the others are body lice and pubic lice. Only body lice can transmit disease; the others are most often simply a nuisance that can cause itching and discomfort.

They can also be a source of embarrassment for families who think that having lice means their home is unsanitary; many lice removal companies promise that they come to your house in unmarked vehicles. But a home's cleanliness has nothing to do with it; lice crawl from one head in close contact with another, or hitch a ride on a hairbrush or comb.

Recent studies, including one presented in 2015 at a meeting of the American Chemical Society, have shown that lice in at least 25 states have developed resistance to permethrin, an ingredient used in many over-the-counter treatments designed to kill lice. In some areas, 100 percent of the lice tested exhibit mutations that make them harder to kill, said the study's lead author, Kyong Yoon.

This doesn't mean that lice are getting bigger and brawnier, but just that they're adapting, as they've done for millions of years. Preserved nits (the term for lice eggs) have been found in the tombs of mummies in South America and Africa; Scientific American reported that a mummy once found in Peru had 545 lice on its head.

There is no new breed of bug; it just means the bugs are harder to kill, said Shepherd, whose nonprofit helps to provide lice removal services worldwide for children whose families can't afford it.

Over the past two decades, however, Shepherd says she has observed that in some cases, lice are laying abnormally small nits, which makes them even harder to detect.

A mature louse which lives about three weeks, is normally about the size of a sesame seed; a nymph, about the size of a pinhead.

Although the CDC says that head lice are most common in children ages 9 to 11, Shepherd says in her experience, girls between the ages of 9 to 16 are most likely to have them. Thats because by this age, girls are taking care of their own hair, so parents cant spot any sign of a problem until theres an infestation.

Lice arent ageists, however. Shepherd has seen them on a 9-day old infant, and a woman who was 98. One-third of mothers who have a child with lice end up getting them, too.

Lice dont have wings; they cant fly or jump. What they do have are claws designed specifically to hold onto human hair, said Nancy Fields, co-founder of Lice Happens, a lice-treatment business with locations across the U.S. I like to say the human head is their planet Earth. What keeps us on Earth is gravity. What keeps them on the human head are their claws.

When separated from their source of food our blood lice can only live about a day, so when Lice Happens recommends washing bedding and stuffed animals after an infestation, its more about other gross stuff (think excrement) than lingering lice.

Of lice and men

Fields recommends parents look for lice in their childrens heads with what she calls a wet screening using a metal-tooth lice comb to run through the hair after a shower, and then wiping it off on a white napkin or paper towel. White flakes of dandruff will disappear, while the brown and tan nymphs and lice will show up. On the head, lice tend to reflect the color of the hair, which is why theyre difficult to spot, she said.

Some health professionals believe that parents can get rid of lice with nothing more than vigorous combing; Boston pediatrician Claire McCarthy wrote in The Boston Globe that she doesn't understand why anyone would put pesticides on their children's head.

"Buy a good comb, and get ready for some quality time together," McCarthy wrote.

For parents who don't have time, there are prescription drugs that promise results in one or two days without combing.

Dr. Albert Yan, chief of pediatric dermatology at Childrens Hospital of Philadelphia, will prescribe some of these agents, but he recommends that families first try an over-the-counter treatment for one or two weeks. While expensive, the newer agents don't appear to be any more toxic than existing OTC products, Yan said.

As for home remedies recommended by some natural-product enthusiasts such as mayonnaise, olive oil and vinegar, Yan said there isnt much good research on their effectiveness beyond a 2004 study that showed petrolatum (petroleum jelly products, such as Vaseline) could prevent eggs from hatching and reduce head lice by two-thirds in about a day. But, he noted, it can take days to get petrolatum out of the scalp.

Applying vinegar may also make it easier to comb out nits, he said. But, aside from making your kids smell like a nice garden salad, home remedies dont work that well, Yan said.

Shepherd recommends families get professional help because lice can spread so quickly and are so hard to see. If parents do try home treatments, she says its important to keep rechecking the scalp even after they think they've killed all the lice.

Dont let your guard down; keep looking. The life cycle of a louse is three weeks. If they keep looking and keep combing, they will eventually get past it, but if they let their guard down, there will be a reinfestation and they will have to keep starting over. If theres one case in the family, theres at least two, she said.

To reduce the risk, children with long hair should keep it tied back, which reduces the chance of spreading, Shepherd said. (Lice tend to enter at the nape of the neck.) And teach children to never share combs, brushes or hair clasps.

Fields, who partnered with her neighbor, a school nurse, to form the business after her sisters children came down with lice, said she has deep respect for lice, even as she tries to eradicate them. (One of the companys mottos is trying to put ourselves out of business one family at a time.

They are incredible creatures. They are survivors, and head lice can tell humans a lot about ourselves. Humans developed head lice back when we were covered head-to-toe with hair, and as we evolved, they evolved with us. Theyre fascinating little creatures, really," Fields said.

But theyre not curious, and have no desire to leave a food supply once theyve found it, which is why they encamp happily on our heads, multiplying without notice until there are enough of them to cause symptoms, which The American Academy of Dermatology says can include an itchy scalp, a crawling sensation, swollen lymph nodes or pink eye.

An itchy scalp doesn't mean you have lice dandruff and eczema can can cause that, too and not itching doesn't mean you don't have lice, either.

"Itching is an allergic reaction to the saliva of lice, and only about 50 percent of people get that," Shepherd said. "But all you have to do is mention lice, and everyone itches," she said.
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