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Lice: How to Get Rid of Lice

Home treatments and how to get rid of lice

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 brown insects fell into the sink. Sesame seeds with legs. Worse, some were bloody. That's because the human head louse, Pediculus humanus capitis, dines on only one food: human blood. (Scream again.)

Still, even with conscientious combing, some nits remained. We combed and combed, twice a day. We washed all his clothes, rolled up his bedroom rug, vacuumed, and changed his pillowcase daily. We had occasional setbacks, whenever we combed out a minuscule baby. Newly hatched. With tiny legs. (Tiny scream.)

I understood from my online research that head lice can only live on the human head. That's where they eat, mate, and lay their eggs. If we could comb out young lice before they could mate — lice do not reach sexual maturity until they are at least 9 to 12 days old — then we would ultimately win the battle.

After a week, the last signs of Jacob's lice were gone, though we continued to check his head. I felt triumphant. But I had made a terrible error.

Fast-forward two months. My 8-year-old son Milo was eating lunch at a Chinese restaurant when he started scratching. "My head has been really itchy lately," he announced.

My stomach sank. Maybe dandruff, I thought. With lice, there are endless opportunities for denial. Milo had a horrible case. Hundreds of nits. (Scream louder.) I'd gotten rid of the lice on one son, only to let them spread to the other! I'd stopped checking Milo's head far too soon. And worse, now they were all over the house. I had lice. Even my husband had a mild case.

I stocked up on Licefreee. I stripped all the beds and washed all the sheets. I washed everyone's clothes. My husband and I stuffed all our couch cushions, pillows, and comforters into garbage bags, where they would remain for two weeks, until the lice were dead. (Lice live no more than two days away from the human head, but the nits can take up to 10 days to hatch.)

And then I had to make those awful phone calls. We'd had three families over for dinner the night before. I had to call all of them with the, er, lousy news. I had to call the school, whose administrator said Milo would have to stay home until every last nit was gone. Unlike New York City public schools, which last fall began allowing children with nits (but not active adult lice) to remain in school, my son's school in Deerfield, Massachusetts, upholds a zero-tolerance policy. Luckily I work from home. Worst of all, I had to break the news to Milo's friend's mother, who is a clean freak. She reacted by spraying antilice insecticides all over her house. (This you should not do. Whatever your attitude toward antilice shampoos, the Centers for Disease Control website says: "Spraying the house is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin.") Not surprisingly, the friendship has been strained ever since.

Still, I understand why she sprayed. Lice carry a stigma. They're embarrassing. 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 of Pediatrics, between 6 million and 12 million Americans (most under age 12) get head lice per year.

Five days after we first found Milo's lice, the school nurse examined his hair under a huge magnifying glass, declared him lice free, and let him back in school. I drove home and drank a glass of vodka, straight up.

My Chemical Romance

Twenty years ago, clinical trials showed that nearly 100 percent of adult and juvenile lice were killed by shampooing with permethrin (in Nix) and pyrethrins (in Rid).

Since then, however, lice have evolved. They've gotten tougher. Technically speaking, it's incorrect to say that the insecticides have caused lice to toughen up. Rather, some lice randomly mutate in a way that provides resistance to insecticides, and the mutants are the ones that survive, says John Clark, a professor of toxicology who studies lice at the University of Massachusetts in Amherst. "If one of these mutations leads to insensitivity so that the compound no longer kills the individual," he says, "then that individual becomes resistant. It survives, reproduces, and then that mutation is basically fixed in the population." Survival of the fittest.

The truth is that when I used an insecticide the first time, I was helping select for a stronger louse. Any lice that survived my son's treatment may have had a mutation that made them harder to kill the next time.

So doctors and pharmaceutical companies have been looking for different insecticides to fight these tougher lice. Ovide, available only by prescription, contains malathion, considered a relatively safe insecticide. Malathion was sprayed over New York City in 1999 during an outbreak of the mosquito-borne virus that causes St. Louis encephalitis, but as a lice treatment it has not been tested on children under 6. Also, it needs to be left on the head for 8 to 10 hours, which can be uncomfortable. And there is evidence of lice developing resistance to malathion. "Lots of insects have become resistant to malathion,"Clark says, "and there's no reason to think that lice won't."

A last-resort prescription option is lindane, the active ingredient in Kwell antilice shampoo. Lindane was banned by the Environmental Protection Agency in 2006 for use in agriculture. So although I can no longer spray lindane on my corn field, I can still get a doctor's prescription to shampoo it into my son's hair. According to an FDA health advisory, its neurological side effects "have ranged from dizziness to seizures."

The Head Nitpicker

Fortunately, there's a better way, as demonstrated by Abigail Rosenfeld, a professional nitpicker extraordinaire who was profiled in The New Yorker several years ago as "The Lice Lady." Rosenfeld, who lives in Brooklyn and started picking nits for her family and friends when she was 13, sums up her simple method this way: Pour on a white conditioner (which immobilizes the lice and makes them easier to see) mixed with a little baking soda (which acts as an abrasive to strip out the eggs) and comb out the lice using a high-quality metal nit comb. Keep combing for a week or so.

Rosenfeld offered to share her technique because she is a kind person, someone who radiates compassion, exactly the woman you'd want to go to if your head or your child's were crawling with insects. Quite simply, she loves children. Rosenfeld, an Orthodox Jew, has 13 of them. Her youngest is 2, and her oldest, at 22, is married with a child of her own.

Using insecticides is overkill, Rosenfeld says, for a bug that's no worse than an inconvenience and an embarrassment. "Some people struggle with lice for weeks because they don't get the nits out. They only use the shampoos." Regular combing is essential. (For amateur nitpickers like you and me, it does help to start with a product like Licefreee.)

Rosenfeld's clients are rich and poor and everything in between. They come from nearby public schools in Brooklyn and from fancy Manhattan private schools. They drive to her from Westchester suburbs, New Jersey, Connecticut, even as far away as Boston. When I visited Rosenfeld, Mara from New Jersey was missing third grade because her mother had found lice in her daughter's hair. First thing the next morning they drove an hour to Rosenfeld's house. Although Miriam, Mara's mother, had used an antilice shampoo on her daughter's hair the night before, it still contained hundreds of lice in all stages of development, all perfectly lively.

Mara's hair was a real challenge. Rosenfeld can comb out very short hair or a mild case in as little as 15 minutes, but Mara's kinky hair required two hours of steady work. Rosenfeld poured a blob of the conditioner/baking soda goop into Mara's hair. Then, using a German-made stainless steel nit comb called the Nisska, she combed through sections 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 revealed a thriving insect society of adults, nymphs (young lice), and nits. Examining the paper towel, 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, though they were hard to spot in her straight gray hair. After about a half hour she was declared clean. Rosenfeld charges $200 for a mother-daughter treatment like this, including the Nisska comb that Miriam took home. She instructed Miriam to keep combing out her own hair and Mara's every other day for at least a week.

She also gave Miriam cleaning and bagging instructions for bedding, clothes, even stuffed animals that might have touched her daughter's head. Regular laundry cycles are perfectly adequate, Rosenfeld says, as long as you keep combing. "Concentrate on the head, not the house," she says. (The CDC agrees: "Head lice do not survive long if they fall off a person and cannot feed. You don't need to spend a lot of time or money on housecleaning activities.")

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, gave me the confidence and tools to continue the difficult treatment of Mara's hair myself."

Salad Dressing Solutions?

What about home remedies? A recent Journal of Pediatric Nursing study of six common ones showed that petroleum jelly worked best, asphyxiating about 62 percent of lice within eight hours; it also allowed only 6 percent of the eggs to hatch. Olive oil and mayonnaise lowered hatching rates by smothering the eggs, which the researchers submerged for 9 to 10 days (my sons would have objected). Neither vinegar, melted butter, nor isopropyl alcohol killed lice or prevented nits from hatching. Other studies reported that a compound found 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.

And even if it does work, here's the rub: If we all 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. "So it's still chemical control. And any time you use a 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, school attendance, public health, insecticides, and insect evolution.

In the end, I am left with the hands-on approach. I fervently hope that my children never get another bout of lice. But for now, I'll hold on to my nit comb. I'd rather do a little manual labor than contribute to the building of a better louse.

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

The 411 on Lice

Myth: Only kids with dirty hair get lice. Reality: Lice like to live in clean hair too.

Myth: Only low-income families get lice. Reality: Insects don't pay attention to household income levels.

Myth: Lice jump and fly. Reality: Neither is true. They spread through head-to-head contact.

Myth: Lice spread from a shared comb or hat. Reality: Contagion via indirect contact is rare. A healthy louse stays on a healthy head.

Myth: Lice transmit disease. Reality: Head lice might make you sick but they don't make you sick.

Myth:Prominent poets wrote odes to lice. Reality: This one's true: Rimbaud, Burns, and the haiku poet Basho all did.

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CeReality: 5 Families, 5 Stories, 1 Critical Meal

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