As a mother of four school-aged children, Jennifer Barton has become a master at making sure uniforms are clean, homework is done on time and everyone leaves school each day with a healthy packed lunch.
But every year, especially around this time, he has problems with lice.
For the past decade, her children Diana, 14, Liv, 11, Stella, nine, and Ada, seven, have had at least one or two infestations a year between them.
This hasn’t just affected them: it’s also been a problem for Jennifer and her husband Will, 40, who works in finance.
Head lice affect thousands of homes each year in this country, and while cases decreased during the pandemic, they are now on the rise.
Jennifer Barton with her daughter Liv, now 11. Jennifer checks her children’s hair every day, having lost count of the number of times she has contracted lice from them.
The first sign, he says, is “the dreaded itchy scalp.”
‘Even if only one of our children has lice, we treat the entire family with a dimethicone-based lice treatment (a silicone-like compound that suffocates the bugs) until the lice have been eradicated because they spread so easily.’
She also checks her children’s hair every day. “We learned years ago that it’s the only way to keep up,” she says wearily.
Head lice affect thousands of UK households every year, and while cases fell during the pandemic, they are now on the rise, if the market for anti-lice products is any guide (Superdrug reported that sales of treatment spray were up 121 per cent compared to last year).
And the problem is never more acute than at this time of year, when children are back in close contact with each other in classrooms.
Jennifer says, “The first time my oldest son had nits, I was stressed out because I felt overwhelmed. I wasn’t prepared for how prevalent they still are, even as kids get older.”
Most parents dread the email that often arrives weeks after the start of the school term announcing another outbreak.
But while parents are often embarrassed to admit their children have head lice, “they are very common and nothing to be ashamed of,” says Dr Sharon Wong, consultant dermatologist and spokesperson for the British Skin Foundation. “They have nothing to do with personal hygiene.”
Lice are one of the oldest living parasites that adapt to changes in human behavior. As David Reed, associate provost at the University of Florida and an expert in mammalian genetics and their parasites, recently explained to National Geographic, this is made evident by the size of their claws, which are the same diameter as a human hair.
Their ability to adapt is reflected in the fact that when we started wearing clothes, lice developed into two forms: body lice and head lice.
“People often refer to them as nits, but they are actually the empty egg shells of lice,” explains Dr. Wong.
According to a previous Dutch study from 2016, what is driving the rise in cases is the tendency of young people to put their heads together and take selfies.
Dr Wong says this is “possible” as head-to-head contact is the most common way lice are spread. Sharing personal items such as hats or hairbrushes is less likely, according to research from James Cook University in Australia in 2010.
The same goes for bedding: the NHS warns that “there is no need to wash clothes and bedding in hot water as this is unlikely to prevent the spread of lice.”
The popularity of long hair may also play a role. A survey conducted earlier this year by the University of Valencia in Spain suggests that having short hair halves the risk of contracting lice.
However, as Dr. Wong explains, “People with any hair length can get lice, although they may be easier to see and eradicate on short hair.”
Despite their tiny size (an adult louse is about the size of a sesame seed), they can spread with frightening ease. “It only takes about 30 seconds of contact, and that’s easily done in homes and schools,” says Dr. Wong.
That’s why they can easily become ubiquitous among children in playgroups, schools, clubs, and transmitted during playdates and sleepovers.
Jennifer, 42, has lost count of the number of times her children have given her lice. Her first infestation was when her eldest daughter, Diana, was in nursery school.
“The first time my oldest son had nits, I was stressed because I felt overwhelmed,” she recalls.
“I had heard about it, but I wasn’t prepared for how prevalent they still tend to be, even as kids get older and enter high school.”
During a lice attack, Jennifer was pregnant with her youngest child.
After another mother alerted her to this possibility, she immediately checked her own daughter and found a couple of lice.
She was concerned about using chemical treatments, so she enlisted her husband’s help in treating the problem with conditioner and wet combing (combing wet hair using a fine-toothed nit comb and a thick conditioner, which effectively traps lice and helps kill them and their eggs).
Consultant dermatologist Dr Sharon Wong says it takes just 30 seconds to catch head lice, and even youngsters who put their heads together to take selfies could be at risk
“Luckily we caught them very early, so there were only a couple of lice and we managed to get them out,” says Jennifer.
While some parents swear by the folk remedy of combing with vinegar, Dr. Wong says home remedies are not as effective as chemical treatments. The best way to get rid of lice, she explains, is to use products containing dimethicone. These “are derived from silicone oil and work by suffocating the lice and smothering them.”
Basically, lice consume more water or fluid than they actually need, which they excrete through the respiratory system. Dimethicone blocks the respiratory passages, preventing the lice from releasing the excess fluid, “which kills them,” says Dr. Wong.
And since it is not an insecticide, it is not aggressive to the scalp.
Dr. Wong also suggests using the wet comb method as a preventative measure, as dimethicone typically requires two applications a week apart.
In the UK there are two insecticides, permethrin and malathion, which work by attacking the insect’s nervous system.
However, more and more lice have become resistant to both. In the 1980s, permethrin had a kill rate of close to 100 percent, but a study published in the BMJ in 2007 concluded that it only killed 13 percent of cases. The same is true for malathion.
The rise of insecticide-resistant superlice “is a global problem,” explains Ian Burgess, a medical entomologist at Insect Research and Development, Cambridge, a centre that advises the NHS on parasites and tests new products.
“Malathion was introduced in 1991 and in 1993 we discovered that there was resistance to it,” he says. “In clinical studies with permethrin in the late 1990s and 2000s, we were able to cure at best 30 percent of patients.”
Ian Burgess says new treatments are on the horizon, although he can’t reveal details: ‘They were just given to me to try, I don’t know what’s in them.
“But even if they are better, we have to be vigilant and make sure that the lice don’t get used to them, because we’ve even seen the odd case of lice becoming tolerant to dimethicone.”
Prevention may be better than cure, but counterintuitively, shaving your head won’t work “unless you do it every day,” says Ian Burgess.
Although some parents swear by the home remedy of combing with vinegar, Dr. Wong says chemical treatments using products containing dimethicone are the most effective.
‘We conducted a study in Bangladesh, where in the summer months children shave their heads because it is so hot. In one place, two twin girls with long hair had lice and one cut her hair until she was bald.
‘The girls shared a bed and after two days the one who had shaved her head had a stubble and lice again.’
For the Barton family, lice prevention is a military operation in which parents periodically check for new signs of infestations.
“My husband is amazing at removing lice with a comb. We also treat the problem as soon as we spot a louse and repeat the treatment after a few days, combing daily in between each step,” says Jennifer.
‘Hair is kept in a ponytail, brushes are disinfected, sheets, pillows and clothes are all washed. You have to keep an eye on everything. Our nine-year-old recently had them at a sleepover and it took him several weeks to get rid of them.’
Dr. Wong agrees that such surveillance is key, along with simultaneous treatment of all family members, regardless of whether they have been infected or not.
And most importantly, he adds, “be patient.”