2. I instantly follow medical instructions and use the shampoo that is supposed to kill live lice, and begin combing to remove nits. Do I still have to tell anyone?

Yes — as answered in question #1, informing other adults of children who have close contact (neighbors, sleepover friends, sports team friends, classmates, scouts etc.) will promote their early identification and treatment of lice too, and prevent the continued re-infestation of your own child and others.

Product claims can be misleading. We are unaware of any chemical treatment that is 100% safe or effective against lice and their eggs (nits). “Begin” combing is a step in the right direction but “if you don’t get them all out – you’ve still got them.” Pediculosis is a communicable disease. Parents appreciate the earliest possible notice of an outbreak so they can be especially diligent in checking their families. Otherwise they understandably may feel disappointed and angry. We must all be sensitive to the reality that many children have already been exposed to pesticides for earlier head lice infestations multiple times. The earliest possible notice of an outbreak may help other parents avoid future infestations and the risks of additional chemical exposures. The NPA's "No Nit Policy" is here.

Richard Pollack, PhD, IdentifyUS

If you believe you've taken reasonable steps to abate the infestation, then why act as if the problem still exists? Doing so risks alienating your child from you and from his/her friends.

Unfortunately, the over-the-counter shampoos that were once effective are no longer reliable. They continue to give many people a false sense of security regarding successful treatment. Twenty years ago neither Rid nor Nix killed the bugs when my children and I had lice and the pharmacist, who I hoped would refund my money, explained that the bugs were building a resistance to permethrin (the active ingredient in Rid and Nix) and that each year going forward the efficacy of Rid and Nix would continue to diminish. Combing offers greater benefit at this time, in my opinion, provided an effective, high quality comb is used—most are not. Personally, I consider it essential to continue daily checks and combing for a minimum of two weeks after the last bug has been seen. During this time I consider it a courtesy to let family and friends make their own decision about having contact with your family.

If you haven't told anyone that your child was recently treated for lice, you need to do so because it is likely that other children may have live lice hatching and the spread may continue if those children aren't treated too. Your child and your children's close contacts should have their heads checked weekly per routine monitoring.

Visualizing lice and nits is not necessarily the criteria for being a proactive voice. Encouraging others to screen their children is an ongoing measure that will help protect your family as well as theirs. Children are vulnerable to acquiring head lice over and over again. Telling others that you are screening regularly may help raise the community standard by reminding others to do the same.

Only if you wish to proclaim to the world that you have (apparently) vanquished your enemy.

If no new lice have been seen for at least 10 days, and head checks have been done daily, I do not consider it necessary to tell anyone, but I do consider it necessary to continue checking daily until two weeks have passed of finding no bugs at all.

As adults we should be able to minimize our spread of lice (and germs) through behavior like not sharing combs/brushes or hats, clipping long hair up, and not engaging in head-to-head contact if we suspect we may have lice. If your head persists with itching, you should comb with a fine tooth metal comb to capture any lice and also have an adult check your head for nits. You do not need to treat yourself preventatively. Some treatments cause itching due to irritation, dry scalps, and other sensitivity. The natural response to the topic of lice is often to make adults start "scratching."

This question is about the anxiety that comes with not knowing what to do. It is also a reminder to screen yourself regularly as well. It is also an opportunity to ask someone for help if you need it, and some people do. An effective lice and nit removal comb can allow you to independently screen yourself, document an infestation if you have acquired one – but also be assured when you haven’t! When you have the proper knowledge and tools you can avoid unnecessary worry and be confident when you are lice- and nit-free.

Considering head lice to be the cause of every little itch for the rest of your life is, sadly, a bit of psychological baggage that burdens many folks. Everyone's scalp itches many times a day, whether or not head lice are, or were ever, present. If one suspects that a louse may be present, it is reasonable to check. Absent a louse, the itching may simply result from other causes. If the itching causes distress, it is time to consult with your physician to rule in (or out) other causes. Sharing your suspicion with coworkers and others may cause them to shun you.

A person can check themselves for lice and nits by combing with a good nit comb each day and checking to see if eggs or bugs are getting caught in the tines. If nothing is coming out with the combing, there’s no reason to tell co-workers anything.
In my experience, 70% of mothers whose children are nine years old or younger also have head lice. There is a direct correlation between the age of the child and the likelihood that the mother will also have lice. To the surprise of many, we have occasionally treated a mother whose children did not have lice.

5. When I tell other parents that my child has lice, I learn for the first time that several of their children have had them lately, too. Shouldn't the parents have told me?

Mimi Stamer, Massachusetts School Nurse Organization:
Yes, the other parents should have told you, but unfortunately many people continue to keep it a secret or private. You should calmly express that you appreciate learning now and share why it is important for children's parents to be informed so they may begin checking, treating, and prevent continued spreading.

Deborah Altschuler, National Pediculosis Association:
Communities that speak openly about head lice are in a much better position to avoid embarrassment and overcome stigmas.  Not surprisingly children are often much better at understanding this issue than parents. The silver lining of an outbreak is that it puts the issue in the forefront.  We can learn a lot about our community preparedness for communicable diseases in general by the way we respond to head lice.  Parents need to work together and respectfully communicate on this and other public health issues whenever possible.

Richard Pollack, PhD, IdentifyUS, LLC:
There's no 'right' answer to this loaded question.  For those who have exaggerated the significance of head lice to a major disease status, then you'd likely want every child who has ever been within a mile of an infested person to carry a scarlet louse emblem.  For those who consider head lice to be the most minor of childhood maladies, then the only thing to carry would be a smile, a feeling of camaraderie and some compassion.

Helen Hadley, The Nit-Picker, Inc:
In a perfect world, yes, absolutely they should have told you, provided they had had contact with you in recent weeks. By telling you that their family had lice, you were being granted the opportunity of making your own determination about having physical contact with them—it should certainly not be their decision to make for you.

Mimi Stamer, Massachusetts School Nurse Organization:
Unless your child is living in a "bubble" you will have to expect that he/she may be in contact with others with lice. Considering your child's recent experience and your successful resolution, I would suggest that you share openly with the child's play-date parent about your child's experience and inquire if they have any current concerns or suspicions about their own child having lice. There won't be any absolute guarantee. You will need to continue to monitor your own child's head and accept that lice may re-occur. Teach your child, too, about containing her hats/scarves/coats; not sharing combs and hair accessories, etc.

Deborah Altschuler, National Pediculosis Association:
Prevention isn’t just about preventing head lice.  It’s also about preventing inappropriate responses and risky treatments.  If you are doing the things you can do to secure your own peace of mind by checking your children regularly, you can relax a bit about other children.  And if all the parents are mobilized to do the same, head lice will become less and less of a problem for your family and community.   Screening children for head lice is an ongoing healthy hygiene measure – not just something to do when you hear of another infested child.

Richard Pollack, PhD, IdentifyUS, LLC:
Eliminating head lice should not require much time or money. Most treatments are applied for just 10 minutes, then rinsed off, and then reapplied about 10 days later.  Even for the prescription product labeled for an 8-12 hour treatment, it doesn't take more than a few minutes to apply it and then to wash it off.  A hefty time commitment is faced only by those who insist on trying to render their child free of 'nits' (louse eggs).  That should always be a personal decision, based upon aesthetic issues, as it rarely is a significant or practical means to eliminate a louse infestation.  Note that the majority of presumed 'nits' are inviable or are merely other objects mistaken to be louse eggs.

Might you ask the parents of another child if they're sure their child is free of lice?  You could, but do expect some of those parents to avoid you like the plague.  Asking the question might well be interpreted as being impertinent or intrusive, and certainly a bit overprotective.

Helen Hadley, The Nit-Picker, Inc:
You can ask the other child’s parents if they have checked their child for lice and you can ask for their assurance that no lice were found. However, not everyone who has lice knows it. Most people wouldn’t know what they were looking for if they tried. Furthermore, it is impossible for any of us to be “absolutely sure” that we are lice free—not your friends, the school nurse, the principal or your physician. Anyone can get lice. Itching does not accompany an infestation of lice with everyone and they could tell you in all honesty that they are lice-free, when in fact they are not.
If your family has recently had lice and you ask another family if they currently have lice, you may find them to be more concerned about their contact with you than you are of your contact with them.

Mimi Stamer, Massachusetts School Nurse Organization:
You should not be inspecting another child's head without the permission of the parent.
You may ask that your own child's hair be tied back and wear a hat but you can't request that of others unless you have a conversation with the other child's parent.

Deborah Altschuler, National Pediculosis Association:
Many of these questions unfortunately reflect a reactive and very common counterproductive mentality.  Better to have a community that is proactive — mobilized in advance of outbreaks.  This is the spirit of the NPA’s No Nit Policy.  But be aware that No Nit Policies can vary greatly from school to school.  Too often they are spoken of as though they are all the same.  Many policies such as "live lice only" policy are reactive and treatment-based.   A true No Nit Policy is proactive and prevention based.  Prevention is again not just about head lice, it is also about preventing inappropriate responses and unnecessary exposures to potentially harmful chemicals and pesticides.

A true No Nit Policy does not sacrifice relationships for the goal. A true No Nit Policy is respectful and science-based rather than punitive or fear-based.  It is about education, preparation and sensitivity to the many variables affecting each child in the group setting.  NPA’s policy recommendation could have been called a “Policy for Pediculosis Etiquette”.   A proactive community effort assures that everyone is accurately informed, enabled, and ready to respond with safe and effective tools.  This will also help avoid surprise, panic and unfair expectations that certain treatments are entirely safe and effective when they are not.  Be cautious of information that persuades you to believe head lice are a nuisance and not a health problem.  It is never healthy to directly and repeatedly expose children to pesticides especially when safer choices are available.  It is always best to remember and respect the fact that head lice are very important to the people who have them.

Richard Pollack, PhD, IdentifyUS, LLC:
You can ask, but expect your child to lose many friends this way.

If you expect the child will be working in a food handling establishment, then it would be fine to confine the hair in such a manner, as per relevant regulations.  Otherwise, I believe this request would be completely unjustified, bordering on an hysterical overreaction.

Helen Hadley, The Nit-PIcker, Inc.:
You can ask to inspect the head of another person's child but without the consent of the parent you have no legal right to touch their child at all--for any reason.

You have the right to ask that a visiting child have their hair back or that they wear a hat. By the same token, they have the right to refuse. If the request suggests that you are distrustful of the other family, they will probably be offended, perhaps irrevocably. A better option would be to say that, in light of your child's having recently had lice, you would be more comfortable if both children have their hair back and/or wear a hat. They can then decide for themselves how they want to handle the situation for their child. Alternately, you could say that because lice are going around their classroom, you’d be more comfortable avoiding play dates entirely or at least agreeing to a common set of parameters for the children, i.e., hair pulled back or pinned up, no sleepovers, no dressing-up activities, no playing with each other's hair, etc.

It doesn’t work to anyone’s advantage for one parent to unilaterally control the activity and behavior of another family’s child. However, inviting the other parent to think through each of your concerns about the spread of lice between your children allows you to establish mutually agreed-upon terms for the children's activities together.

Mimi Stamer, Massachusetts School Nurse Organization:
You need to manage your own child and control your own child's close contact with other children who you have concerns about. If the other child is in school, you may express your concerns to the school nurse, and she may be able to use that insight to educate all parents about lice occurence and management, as well as follow up if appropriate with the parent/child of concern.

Deborah Altschuler, National Pediculosis Association:
Energy spent placing blame is wasted energy.  Be proactive!!

Richard Pollack, PhD, IdentifyUS LLC:
Try to ignore rumors, as they tend to be unfounded.  Repeating such rumors to others can damage reputations and destroy friendships.

Helen Hadley, The Nit-Picker, Inc:
Taking action based on rumor shouldn’t happen under any circumstances and hopefully our children learn this from our example.

wowwxer/flickr CC

Mimi Stamer, MSNO:
If you have a relationship with that other child's parent, you may speak to him/her about what your child has shared and offer to help or advise. You may also share the concern with the school nurse and she will follow up appropriately. Lots of children hear, see, or say things about lice that are not accurate so you don't want to panic due to what your child says. You may stress to your child the importance of their personal lice prevention behavior- no sharing of head accessories, hats, head-head contact, keeping hair pulled up and back, etc.

Richard Pollack, PhD, IdentifyUS, LLC:
Smile and embrace the opportunity to educate yourself and your child about the fascinating biology but insignificant health concerns associated with head lice.  Similarly, exploit this chance to discuss the acceptance of others and of compassion.

Helen Hadley, The Nit-Picker, Inc.
I have heard of parents calling the school nurse anonymously and letting them know about a known case of head lice in the school. The nurse will take it from there in whatever consider appropriate.

(The following questions come from a friend in a shi-shi New York suburb:)

Mimi Stamer, MSNO:
You must remember that lice is not a life-threatening contagious disease... so if your child needs a hug and a snuggle from her mom, you need to be there for her. You may protect yourself by treating your child's lice per the directions on the shampoo, picking out nits daily, cleaning her combs/brushes, bed linen; I would suggest you clip your hair up, and snuggle...Comb your hair afterward to remove any live lice. Lice don't fly or jump!

Deborah Altschuler, NPA:
Fear to hug one’s child because of head lice may contribute to more fear and chaos.   Parents need to step up and show children that while this may disconcerting, it need not be a crisis.  Informed parents are more likely to be confident, calm and careful about how they handle the situation.  Children also need to know and understand their part — that they will need to cooperate with special time and attention to help mom and dad remove all the lice and nits from their hair.  But it is good to avoid burdening them with our own fears, understandable as they may be.
This said, feeling shunned may still be a reality for some children who experience head lice. People who are afraid will taunt others they perceive to be vulnerable. This is a much bigger issue than pediculosis!  Too often, people are afraid because there has been no collective will to teach them not just about head lice but also about being kind and sensitive to others.  Pediculosis can be a learning experience for everyone.  Explain that sometimes there aren’t perfect answers but that you will always do the best you can to help your daughter.  Comb her thoroughly with a quality lice and nit removal comb and assure her that all the lice and nits have been removed from her hair.  Even if it takes several sittings, she will know she is getting the attention she needs. Always be aware that parents set the behavior standard on pediculosis.  This is a great opportunity to teach your child healthy behaviors.

Richard Pollack, PhD, IdentifyUS
Get over your fears, and do so quickly.  Acting as if your daughter has a highly contagious and fatal condition (head lice are neither) serves no purpose but to harm yourself, your daughter, and your relationship. Your child deserves hugs, whether or not she has lice.  What would you do if she actually had something serious?

Helen Hadley, The Nit-Picker, Inc.:
Comb your child’s hair for 15 to 20 minutes with a fine-toothed comb. If nothing comes out, give your child a hug.

Mimi Stamer, MSNO
This is confusing to hear as most school nurses are totally interested and involved with lice prevention and management. It is a team responsibility — parents and schools. As for the pile of coats, I would talk with the teacher, principal, or program director about other options for the children to store their outerwear. You may want to set up a meeting with the principal and school nurse to discuss together how lice may be managed and how parents may help the schools, too. It is the school nurse's role to check children's heads in schools and communicate with parents but it is the parents' role to check their own children's heads and treat lice as necessary, and the principal's role to support a healthy environment for all.

Deborah Altschuler, NPA
Nurses have many challenges and multiple responsibilities in the course of the day. It is unfair to assume that they do not take this issue seriously.  Sometimes the school nurse may be responding to what is perceived as a judgmental attitude.   School nurses will appreciate a parent population that makes head lice awareness important and does its best to send their children into the classroom lice and nit free.  Read and share NPA’s No Nit Policy. It’s a roadmap for proactive strategies that are all about setting the highest possible standards for children, parents and the entire community.

Richard Pollack, PhD, Identify Us
The school nurse's responsibility is to focus on real health issues, not minor maladies or annoyances.  She likely has many hundreds of kids to oversee every day. Some kids need first aid, others require help monitoring physiological parameters or dispensing medications.  Asking her to spend time on something as trivial as head lice is a poor use of her time.  It may even violate terms of her contract or license.  Head lice infest children, not school buildings.  The school nurse's responsibility on louse issues should be limited to helping to educate parents on how to ensure a child's condition is properly characterized and managed.

Helen Hadley, The Nit-Picker
I have read that across the country schools have changed their lice policy in recent years—the No-Nit policy has virtually disappeared. Many, or most, schools now consider head lice to be a family’s issue and not the school's responsibility. The No Child Left Behind Act states that if a school meets certain criteria it qualifies for additional federal funding. High attendance rates and high test scores are among the criteria cited, each of which is adversely affected by absenteeism due to head lice. I know of many families that challenge their school’s new nit policy but have not heard of a parent who succeeded in effecting change within the public schools.
The issue of tossed sweatshirts is an easier topic to address. There are schools in the Boston area that have allowed the use of a draw string bag for each child’s hat and coat that hang from coat hooks. However, I only know of cases like this in which PTC funds have paid for the bags. I have also heard from teachers that in theory it sounds good but in reality the children are finding it too time consuming to bother with and coats end up on the floor as before

Mimi Stamer, MSNO:
Lice need the human scalp to live so they can not be passed on by movie theatre or restaurant chairs etc. It is the head of a person with lice that passes on lice.

Deborah Altschuler, NPA:
Screen your children for lice and nits before and after they go to the movie theater.  This gives you control of the situation no matter what.

Richard Pollack, PhD:
Rumors spread faster than can any natural infection or infestation.  Parents should educate themselves so they can sort the wheat from the chaff of misinformation, then do their best to inform their own kids as to the facts. Kids have a surprising capacity to learn about rumors as well as the damage that can be wrought by spreading them.

Helen Hadley, The Nit-Picker, Inc:
We take lots of risks each day that begin with stepping out of bed in the morning. Bringing in the mail during an ice storm could potentially result in a fall that could crack your head open—or worse. But we don’t stop to consider whether bringing in the mail is worth the risk.
In my opinion, the potential of getting lice from a movie theater seat, a booth in a restaurant or an airplane seat does not pose a high enough risk to stop a person from going to the movies, a restaurant or boarding an airplane. If a person is concerned about the potential of getting head lice from any of these places, they can always check their child’s head for lice and nits when they get home. If you do decide to check for nits, do it during daylight hours, if possible, and check just the first inch of hair, primarily around the outer perimeter of the hairline. The hairs around the ears and across the back of the neck are the most likely spots to find them. Combing with a fine toothed comb is an effective way of finding and removing nits from these areas as well.

Mimi Stamer, MSNO:
No nit policies and mass screenings are not recommended as effective by medical and public health experts. Having PTA sponsoring lice pickers sounds inappropriate as well, violating children's rights. The school nurse should check children's heads if necessary and maintain the privacy and respect for the child if live lice are found. Children do NOT need to be immediately excluded from school if they are noted to have lice. Parents are notified and treatment is to be initated as soon as possible.
Helen Hadley, The Nit-Picker, Inc:

Deborah Altschule, NPA:
Oh my!  Children don’t “flunk” because they have head lice.  This is an unfortunate judgment.   Encourage the school administrators to employ a more sensitive approach.  Screenings can take place before the end of the school day when parents will be coming to pick up their children anyway.  The key is to let parents know about such screenings in advance.  This is the respectful and responsible thing to do for parents and and their children. This will hopefully encourage them to screen their children at home before sending them to school that day.

Richard Pollack, PhD, IdentifyUS:
Service providers who 'pick nits' or comb or treat for lice should be welcome to offer their wares in the marketplace, but not in the school.  Provide scientifically and medically relevant resources to PTA members, and explain that many common actions and policies are based upon long-standing misinformation and fear. Explain to the PTA and the school administrators that their screening and exclusion policies are inconsistent with modern accepted medical practices.  Continuing to pursue these practices unnecessarily punishes the child and her parents, and risks inciting legal action against the school.

Helen Hadley, The Nit-Picker, Inc:
You could sit down next to the child and say, “Let’s wait here together until your dad comes”. Later you could point out to the nurse that it seemed unfair and unnecessary to you to do this to a child and you could remind the nurse that medical issues are supposed to be confidential—even for children.

Mimi Stamer, MSNO:
Your friend's mother needs education about treatment. Buckets of ovicidal shampoo is dangerous for the child. Treatment usually involves two shampoos spaced a week apart and the daily combing and nit picking for as long as necessary, which is usually a few weeks.

Deborah Altschuler, NPA:
To the best of our knowledge there is no such thing as a chemical that will do it all.  This is one of the many reasons the National Pediculosis Associatioin is adamant about the importance of early detection and combing out all of the lice and nits.  Children are vulnerable to the risks of chemicals designed to kill lice.   Many parents have no idea that lice shampoos are pesticides.  There is an old medical proverb that fits the seemingly endless list of products on the market for children with head lice — "When there are a lot of treatments for a disease you can be sure there's no cure."   Do what the researchers do to collect data.  Use a quality comb (NPA recommends the LiceMeister comb) and remove all the lice and nits.  When they are all out of your hair — you don't have them anymore!!

Richard Pollack, PhD, IdentifyUS:
Offer guidance and compassion.  Make sure the mom understands that treatments are warranted solely if live (crawling) lice are found on the scalp hair.  Treating for nits is unwarranted.  Next, make sure the products have been used properly, and that others in the home have been checked to make sure they're not harboring their own populations of head lice.  If live lice persist, the mom should converse with the family's pediatrician to weigh the options, including the use of available prescription pediculicides.

Helen Hadley, The Nit-Picker, Inc:
If the person is a close friend you could challenge her assumptions about the value of and the risk inherent in using chemical shampoos, especially by the bucket-load. If the person is not a close friend, I wouldn’t consider it to be my business to do or say anything unless I was asked or unless I was avoiding including her child in my child’s activities. In that case I would let them know my concern about their child and your own being together because of the head lice issue. I would hope the other parent would assure you that their child has been treated or is being treated regularly. This would be the point at which you might challenge their assumptions about the use of chemical products for the treatment of head lice.

And to end a positive note, twelve most comforting things to say to a parent dealing with head lice:

Comforting thoughts from our experts and our friends:

1. This, too, shall pass.

2. It's not your fault.

3. Let's face it, childhood is basically a series of infestations, from viruses to pinworms to bugs — if you get upset at each one, you'll make parenthood (and childhood for your child) much harder than it has to be.

4. Of all the bad things that can happen, this is perhaps the least bad — there's essentially no danger, it's just a giant pain in the neck — or a little itch on the scalp.

5. It might help to think of them like food moths in your pantry — you have to deal with them and they carry a gross-out factor, but that's all.

6. A child with lice is a child with friends. (That is, not that the lice are friends! But that they likely caught the lice through close contact.)

7. You're in very good company — prevalence numbers are blurry, but it seem to be in the millions of Americans each year, and if you ask around, it seems like almost everybody has been there.

8. Lice are no reflection on a family's hygiene; one oft-repeated bit of lice lore is that the cleaner the hair, the more they like it.

9. You're part of a loooooong tradition: lice have been with humans just about forever.

10. You'd never choose it, but treating lice can give parents some nice one-on-one time with children as they comb out nits, and help children learn to face (low-level) adversity.

Helen Hadley of The Nit-Picker offers these fine moments of true friendship, shared by clients:

11."I'll be over this afternoon to take a turn at nit-picking. You need a break!"

12. Tucked into an FTD bouquet of spring wildflowers was a note from friends that read:
"We know how awful it is to have lice. . .but we survived it-- you will too."