Effect Measure

Lice go to the head of the class

A recent letter on the worldwide prevalence of head lice in CDC’s journal Emerging Infectious Diseases made me nostalgic for the good old days when our two kids were in daycare (they are both adults with children of their own in daycare now). In particular, I got to thinking about the days when I was active as an officer in the American Public Health Association (APHA) and many years made the yearly trek to its large annual meeting. While it’s a large meeting, usually over 10,000 with scientific and business sessions spread out over many hotels, there is usually one headquarters venue where the Exhibitor’s Hall is located. This is a huge space with booths rented by businesses, drug companies, device manufacturers, government agencies like CDC and NIOSH, scientific book and journal publishers and most schools of public health. Lots of these places give away little trinkets or free samples to encourage you stop by and chat. Condoms are a perennial favorite (the supply is usually gone before the end of the four days of meetings). The other big free sample draw was head lice shampoo and lotion. I always stocked up.

I had good reasons for hauling the stuff home. The day care center our kids went to would periodically have outbreaks of head lice. It was the kind of cooperative enterprise where parents didn’t just drop the little dears off and then high tail it to work but one where parents also had jobs to do (there were professional teachers, too, of course and unfortunately the enforced parent labor didn’t make it cheaper). There were about 60 kids divided in four age groups, from infants to pre-school. My job was to be the center’s “doctor.” That didn’t mean I provided pediatric care. It meant I dealt with any health issues or problems that came up. Since this was the kind of day care center where even the ice cream had to be made of whole wheat (I’m joking, but not by much), being saddled with the job of medical guru for this group of aging hippie and academic parents was a sign I must have done something very bad in a past lifetime.

There is an idea that head lice are the exclusive province of the poor or unhygienic. It is not supported by the evidence but has stigmatized the condition to the point where it can become a significant stressor for children and their parents, either because they have been found to have head lice or they are afraid of getting head lice. This wasn’t so much a problem at our daycare center but it still freaked out the parents. Unfortunately I soon learned that all the free lice shampoo I was hauling home from the APHA convention was destined for our personal use only. Lotions or shampoos with pesticides like pyrethrins or malathion were not the kind of medical intervention on the agenda for this group. Instead the solution was to set up a security screen at the entrance to the center that the TSA could take lessons from. Each scalp got an inspection and comb with a fine tooth louse comb.

Well it turns out that using a louse comb on conditioned hair to remove nits (nits are louse egg cases that are stuck to hair shafts) and to detect live lice is among the most effective control measures. Lice have started to develop resistance to insecticides and the potential toxic issues in young children also is a disincentive for using them for many people (opinions vary on this). We weren’t quite so strict about our own kids. Of course we participated in the overall program but then shampooed their hair (and sometimes our own, for good measure) with the freebies I picked up in the Exhibitor’s Hall when they got home. Our kids seem normal — which means they periodically have Mrs.R.and me tearing our hair out, but not for lice control.

For those of you now in the head lice business, here’s a good fact sheet from the Department of Public Health in the state of Washington. It tells you how to get rid of lice both with and without the use of insecticide shampoos. And here are a couple of pictures and a video clip for your viewing pleasure:


Source: NIH


Source: LisaJohnson.com

This clip shows a louse crawling around the scalp of a child. Enjoy:


  1. #1 HP
    August 17, 2008

    When I was a kid (as in “prime age for head lice”), I never heard word one about head lice. This was in the late-60s/early-70s. I remember learning that “cooties” were strictly imaginary. Later, as I headed into the teen years and early adulthood, there were articles about head lice outbreaks in the papers. By the time I was in college, I was told never to wear someone else’s hat.

    What changed between the 70s and 80s to lead to lice outbreaks? And why are lice still a concern?

  2. #2 revere
    August 17, 2008

    HP: The late 70s early 80s were good times for head lice. Then they seemed to disappear and now may be back again. I had heard they go in pandemic cycles and tried to search the literature on this but wasn’t able to confirm it. On the contrary, some studies of national prevalence (e.g., Israel) indicate a pretty steady annual prevalence, although it is seasonal. So I’m not sure what the answer is. There is not much good descriptive epidemiology available so I’m not sure whose experience is typical — or not.

  3. #3 mcp
    August 17, 2008

    In the late 80’s my adorable little son routinely brought home louse notices from the oh so proper suburban Quaker school he went to. My girlfriend swore that the kids in her 99.9% African-American, 100% poor public school where she taught never got head lice. She suspected, on no particular evidence, that most of her students used various hair dressings that somehow discouraged infestation. Is anyone aware of any ethnically-based differences in distribution, at least in the United States?

  4. #4 revere
    August 17, 2008

    mcp: Not much work done on this but some of the foreign data (the link in the post takes you to the article in EID which cites it) supports that conclusion. If true, it may have to do with hair length or the nature of the hair shaft, but that’s pure speculation.

  5. #5 daedalus2u
    August 17, 2008

    That sounds like the daycare where my children went, on a certain street in Cambridge that started with ‘O’?

    In the 6 years our children went there (in the 1990’s) there were no outbreaks that I remember. But there were all sorts of discussions of what to do if it should happen.

    Insects get O2 by diffusion through little holes in their exoskeletons. Water can’t enter because of surface tension, but mineral oil has a low enough surface tension that it would enter and greatly reduce the diffusion of O2. I would think that if you slathered enough mineral oil on your hair and left it there for 10 days before washing it out, that lice could not survive that. That might be part of what is happening with the conditioning treatment mentioned in the link.

  6. #6 Old Bogus
    August 18, 2008

    Like the jingle, “Use Wildroot Cream Oil, Charlie”. Slick down, lice will drown?

  7. #7 been there
    August 18, 2008

    oh yes. Well I remember the first time my eldest came home from day care with these things. I was very upset, sure my child would be stigmatized for for life. Only the poor developed this. Now years later, after multiple infections of all three of my children, I accept it as part of the day care experience. The pharmacist I used in the 80s claimed the resurgence of head lice was because DDT was no longer used. I have also heard that the hair shaft of Caucasians is preferred over other ethnic groups. My concern these days is more about what blood born diseases can be spread by the little critters.

  8. #8 daedalus2u
    August 18, 2008

    My mother was an RN, CNM and worked in Frontier Nursing in the backwoods of Kentucky delivering babies. She and my dad were dating then, he lived in the greater NYC area working as a chemical engineer. In writing to him, she complained about all the lice and fleas and so he got her a pound of this white powder which worked absolutely great.

    It was a pound of that new wonder material DDT that he got as a courtesy sample from the manufacturer.

  9. #9 Sam Dawes
    August 18, 2008

    The insecticide in one of the common lice treatments (Kwell) was lindane. This is considered a class 2B carcinogen by IARC and is “reasonably anticipated to be a human carcinogen” in the 11th Report on Carcinogens. Maybe the crunchy granola daycare parents were ahead of their time and not just out in left field.

  10. #10 revere
    August 18, 2008

    Sam: Could be. They certainly were right about a lot of htings. And the Kwell — free bottles of which I happily brought home — turned out not to be the best way to go.

  11. #11 mara
    August 19, 2008

    Everything is so complicated today.When I was a little kid, at the first sign of nits, we all had a number 1 cut and liberal application of turps to the head. Yeah, the smell was a slight issue but, on the plus side, we thought twice about smoking.

  12. #12 g336
    August 19, 2008

    Hey Revere-

    Slightly off topic but what about bed bugs?

    More specifically, an article in BoingBoing links to a travel review site (Trip Advisor) where numerous travelers say that the Carter Hotel near Times Square in Manhattan has a HUGE bedbug problem.

    Many many reviews of bed sheets with lots of little brown spots on them. Many many reviews of people who saw bedbugs, woke up with bedbug bites, and so on. A few reviews saying that people saw rodents in their rooms. And some photos that included bathroom sinks that were seriously cracked (as in right through the porcelain), bathroom shower stalls that had mold growing up to about knee-height on the walls of the stalls, etc. etc. etc.

    Seems to me that it’s so far beyond unsanitary that any city health inspector who isn’t being outright bribed would order the place shut down immediately. Question is: How can one get a place like that shut down?

    Where to complain about that? Would the local media take any interest in the place? And what would have prevented it being shut down thus far? Could they have been bribing the city? Something else?


  13. #13 Stephen L. Tvedten
    August 19, 2008

    You can safely and effectively kill lice with salt water or a sauna – learn how to kill lice without killing yourself or the earth……

    Pediculicide POISONS do not remove nits and are dangerous. Among the reactions to poison shampoo or lice “treatments” are seizures, mental retardation, many different allergies and respiratory problems, strange tingling, burning, itching, attention deficit disorders, brain tumors, leukemia, cancer and death.

    I have used a sauna and/or salt water to safely and effectiely kill lice (but the nits remain).

    I have also used oz. of Safe Solutions, Inc. Lice R Gone Enzyme Shampoo and/or their Enzyme Cleaner with Peppermint per shampoo-type application to safely remove both lice and nits.

    Read how to safely control all pests at http://www.thebestcontrol2.com

  14. #14 Bee
    August 19, 2008

    The public childcare centre I worked for had a lice outbreak every one to two years – shortly after school opened in the fall, when our after-school kids would bring ’em in. Provincial laws don’t allow daycare staff to do anything except sequester the afflicted child, call the parents and hand them a fact sheet (which included much of the info re combs, dangers of pesticides, etc.) plus child.

    Might be useful to write a post with pics of that other occasional scourge of daycares, scabies. That’s an infestation no one should have to endure; adults are supposed to be less vulnerable, but I caught them three times while working with children in an urban area. One small town GP I went to in 1979 had never seen them before and took my word for it that I knew what they were. If, like him, you’ve never seen the symptoms and try to ignore them, they can get pretty bad.

  15. #15 Victoria
    August 19, 2008

    I have managed to keep my children’s hair free of lice for the last five years by only washing their hair only twice a week and by rubbing a small amount of hair conditioner into their hair everyday. The lice apparently hate the conditioner and the dirty hair. Well…..it is better than lice infestation.

  16. #16 Jimmy
    August 20, 2008

    Yup, the Head Louse is Old School. The bug-o-the-day is BedBugs- resistant, resurgent and coming to a home/hotel near you.

    Trust me from having both critters, the BB experience is far more stressful than our children bringing home some lice. Shame and embarassment is only the beginning. Next comes panic when you realize you have been subjecting your neighbours, family and friends to infestation risk daily for probably months. This infestation lives in your electronics, walls and floors as well as your clothes and furniture and hides in your packsack, briefcase and shoes.

    Despite the burgeoning press accounts most people haven’t a clue what to look for or what to do when infested, frequently throwing out expensive furniture and clothing in the initial panic. In many instances the tendency is for people to keep mum whilst they spread them around from not following the rigourous protocols required to confine and remove them even while being treated.

    Pest control professionals charged my apartment manager $450 for one hour of treatment (not repeated despite the PCO Company policy) which was duly removed from my damage deposit despite renting an already furnished suite. The cost of professional fraud that takes place daily is breathtaking and dismaying when you consider the stress of the whole experience on the infested.

    All in all I paid $1200 for treatment, storage and cleaning and I believe I got away lucky.

    Lice. Ha!

  17. #17 david
    September 21, 2010

    ewww jimmy. i cant imagine having
    head lice and body lice at the same tim.e i imagine them crawling in my skin and head. i would have died of shame if i knew i have both. you have strong power my friend

  18. #18 head lice
    October 7, 2010

    Nice presentations 🙂
    All we had a number 1 is reduced and the free use of TURPENTINE head. Yes, it was the smell a little problem, but on the positive side, we thought twice about smoking.

  19. #19 poppy marquez
    richmond va
    March 8, 2013

    There is a new product called Licefreee developed by a mom/nurse. It’s actually just salt water. I used it and it worked well. I would think you could make some yourself too. Supposedly it kills the eggs too but I am not sure, and most schools have a no nit policy (eggs) so I put conditioner on later and just comb and comb (rinse or wipe the lice comb each pass). I also have heard essential oils of lavender, tea tree (may be irritating to scalp), and rosemary are deterrents but prob don’t kill them. I also flat ironed her hair. supposedly heat kills them but I don’t know if the egg is so close to the scalp the flat iron can actually come in contact with it (you don’t want to burn a tender little scalp). All of these methods (licefree salt water spray, my friend used the gel with success it’s the same thing, combing w fine tooth comb and conditioner, and washing all bedding on hot or put in a dryer – worked the first time and they didn’t come back). Well now 6 mos later we have it again! so I am hoping the same measures work

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