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Ideas | Kate Darnton

Why do Americans freak out over lice?

Parents combed children’s hair to see if they are infested by head lice at a primary school in Scheveningen, Netherlands.
Parents combed children’s hair to see if they are infested by head lice at a primary school in Scheveningen, Netherlands.REMKO DE WAAL/AFP/Getty Images/File

AMSTERDAM — Got lice in your house? If you live in the United States, you’d better keep quiet about it. Deal with it on the down low. Hire a high-end professional service (perhaps the $200 60- to- 90-minute “AirAllé” treatment in Newton Upper Falls?). Otherwise, you risk being shunned by your community. You’ll suffer sideways glances on the playground, and have play dates canceled for weeks.

In many American school districts, a student found with lice is immediately sent home. In Medford, where school officials have been debating the issue in recent months, allowing a child to stay in school even until the end of the day has been put forth as a progressive reform.

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In the Netherlands, where my family and I currently live, getting lice is like getting pimples; it’s a simple fact of life. Here, there’s a new TV comedy series “De Luizenmoeder” — “The Lice Mother.” It’s a hit because lice mothers are a real phenomenon: mothers (and the occasional father) who volunteer to check heads at school, sometimes as often as once a week. One lice mother I spoke with at our school likes to pick the live lice out, then preserve them between strips of Scotch tape so that students can stop by her desk to admire them (“Ooh, that’s a big one!”).

There’s no hysteria at our school. No public shaming. No separating infested kids out or sending them home early. Just frequent reminders to check heads. Because everybody gets lice at some point; it’s a perfectly normal part of Dutch childhood. “Getting head lice is a simple case of bad luck. . . You are not the only one to have head lice,” the country’s National Institute for Public Health and the Environment informs children who visit its website. “You cannot help it.” For parents, the message is equally direct: “Head lice [are] absolutely no drama. Do not blame yourself if your child has head lice.”

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Head lice in the United States are perfectly normal, too. The Centers for Disease Control and Prevention estimates that some 6 million to 12 million lice infestations occur each year among children 3 to 11 years of age. Yet the taboo persists in America, where lice are something to be dealt with privately and secretly. And it is precisely this secrecy — caused by social stigma — that works to the head louse’s advantage.

In the Netherlands, WhatsApp messages ping my cellphone every so often: Another parent, matter-of-factly letting everyone know that little Lotte or Luuk has lice, and that other families should keep an eye out. To the extent that Americans’ shared attitudes towards head lice — our feelings of disgust, embarrassment, fear, and shame — discourage parents from speaking up earlier, they help to perpetuate the pesky nits.

I began to wonder: Given that the United States and the Netherlands are similar in fundamental ways — both wealthy, industrialized Western nations with well-developed educational and health care systems — how did something that’s so unremarkable in the Netherlands become so taboo in the United States? Why are Americans so freaked out by lice? Are the Dutch missing something, or are we?

* * *

Our kids still attend summer camp in Massachusetts — a place where, on registration day, all children must present their heads for the dreaded lice check, a solemn procedure during which trained nurses in medical gloves take children, one by one, to private rooms in order to scrutinize their scalps. There’s a firm “no nits” policy at our camp. Any sign of nits or live lice and a child may not participate in any camp activities, potentially forfeiting both the hefty camp fee and his or her parents’ sanity. Last year, the pre-teen girl in pretty French braids ahead of us in the lice line burst into tears and fled. We never saw her again.

This blame-and-shame approach, say experts who study head lice, is based on a misunderstanding — a historic confusion between body lice, which do transmit life-threatening diseases such as typhus, and head lice, which do not carry disease and do not cause mortality. “Our grandparents didn’t discriminate between head and body lice,” Richard Pollack of the Harvard T.H. Chan School of Public Health told me in an e-mail.

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“Attitudes about head lice are culturally constructed,” explain Julie Parison and Deon Canyon, Australian academics who, in 2010, wrote one of the few social science investigations on the subject. “These reactions go beyond what is appropriate for such a benign disease. Instead, we see in these emotions about head lice, evidence of socially constructed ideas about cleanliness, disease, public health, parental roles and class-based stereotypes.” Dr. Gordon E. Schutze, a Baylor University medicine professor who co-authored a 2015 American Academy of Pediatrics report, put it more directly: “Many people equate head lice infestation to being unclean or to being in the lower socioeconomic class, which is not true.”

The academy is working hard to clear up the confusion. In 2010, the organization updated its guidelines to adopt a “do not exclude” policy for students with head lice. The National Association of School Nurses revised its own position the following year: Children found with live head lice should remain in the classroom. The Massachusetts Department of Public Health (MDPH) Bureau of Infectious Diseases encourages schools to abandon long-standing “no nit” policies: “No healthy child should be excluded from or miss school because of head lice.”

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But public school systems have been slow to catch up with expert recommendations. These recommendations have caused uproar among parents who fear that a child with head lice will infest others at school. Their concerns, however, are often based on misinformation about how head lice is most commonly transmitted (via direct head-to-head contact) and dread over having to deal with the head lice treatment, which can be messy, expensive, and time consuming.

In the United States, the usual answer to lice involves chemicals and consumerism. We turn first to over-the-counter anti-lice shampoos and rinses. Over the last five years, however, lice have shown increasing resistance to the most common chemicals found in these products, including pyrethrins and permethrin (for many years, the active ingredients in Nix and Rid), giving rise to every parent’s worst nightmare: the pesticide-resistant “super louse.” Newer prescription pediculicides, such as those containing malathion (Ovide), benzyl alcohol (Ulesfia), ivermectin (Sklice), and spinosad (Natroba), have been effective at killing “super lice,” but they require a trip to the doctor’s office — and they can be pricey.

Then there’s the AirAllé, an FDA-cleared medical device that looks like a vacuum cleaner and acts like a blow dryer, killing head lice and eggs by dehydrating them with blasts of hot air. Lice Clinics of America — the business franchise that offers AirAllé treatments — has only been around since 2014, but already boasts more than 300 clinics in 32 countries, including six in the greater Boston area.

Looking for a cheaper option? There is a flood of new, anti-lice products on the market (many of them with hand-drawn labels and cutesy names like Happy Heads Scootie-Cootie or Bug A Boo or my personal favorite, Lice Knowing You). These either contain oils such as peppermint or tea tree that do not kill bugs or occlusive agents that can suffocate or dehydrate lice — but you still have to comb the nits out.

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And what would be wrong with that? In fact, the most low-cost and least toxic form of head lice treatment — manual removal — can have one big benefit: social bonding. And it’s social bonding that takes the stigma out of having lice.

These days, the lice comb may be an ugly plastic thing that you grab at CVS on your way home from work, but it has an illustrious history. Boston’s own Museum of Fine Arts has several examples of carved wooden lice combs from Egypt’s Coptic period (AD 364 to 476). The Victoria and Albert Museum in London collects intricately carved boxwood lice combs from the Middle Ages. Some have romantic inscriptions (“vive celle / que jayme” or “May the one I love live”) and imagery such as pierced hearts, suggesting — art historians claim — that they were intended as gifts from a lover.

In his 1981 study of Aborigines in northwest Queensland, Australia, researcher David Trigger observed how head lice grooming rituals helped to bond community members, providing them a legitimate excuse for intimacy. Lice populations were maintained and even encouraged (by people actively transferring live lice to their own heads) so that members could engage in the pleasurable experience of “dunaraba”: searching for nits, then popping them with a special stick or between their fingers or with their teeth. When I asked Trigger why the group he studied chose to see nature as part of nature rather than the enemy, he responded, “Life in the Australian bush involved intimate encounters with many species, and of course head and body lice were among them. . . Head lice were simply a part of the living environment.”

As living standards rise, though, societies become less tolerant of parasites. “We suffer angst from beasts (such as lice) that are usually just minor annoyances to folks elsewhere,” explains Pollack, the lice expert at Harvard. “Ask a resident living in a mud and wattle home in rural areas of Ethiopia about their concerns of lice or bed bugs, and they’ll laugh at you. I know this, because I’ve asked this of many in that country (and elsewhere). They’re far more worried about mosquitoes and malaria, and about finding food.”

* * *

Of course, people in the Netherlands and the United States share a similarly high standard of living, and yet Dutch and American attitudes at some point diverged. In the end, we’re left to speculate why. Perhaps it’s inevitable that a blasé attitude that treats red-light districts and a certain amount of drug use as somewhat inevitable extends to mere head lice as well.

If anything, tolerance for lice has been evident in Dutch culture for far longer. Searching for answers, I turned to the walls of two of the most prized Dutch institutions: the Rijksmuseum in Amsterdam and the Mauritshuis Museum in The Hague. Here hangs evidence of attitudes from Holland’s Golden Age: 17th-century genre paintings of tranquil domestic scenes. Women making lace, women reading letters, women pouring milk and peeling apples and playing lutes, and yes, picking lice.

These paintings, art historians argue, likely contain moral messages for their viewers. According to the Mauritshuis, “‘Hunting for Lice’ probably contains a moral, as maternal care, orderliness and cleanliness were the ideal qualities of a good housewife. In the 17th century, the lice comb stood for both a clean appearance and a pure character.”

I don’t know about you, but when my husband sees me bent over a child’s head, lice comb in hand, his thoughts don’t turn to the purity of my character. They’re more like, “Yuck.”

But he’s not in the bathroom as — following current Dutch protocol — I comb and I comb through our children’s damp hair and we chat. Not about lice, necessarily, but about life. Or the weather. Or whatever.

Will parents in the United States ever discover the benefits of picking nits? The American Academy of Pediatrics report from 2015 raises the possibility: “There is an obvious benefit of the manual removal process that can allow a parent and child to have some close, extended time together while safely removing infestations and residual debris without using potentially toxic chemicals on the child or in the environment. Furthermore, manual removal of nits will help to diminish the social stigma and isolation a child can have in the school setting.”

Lice-combing can be icky and tedious. It’s not my preferred way to spend time with my kids. But it helps them — and me — feel a little less ashamed of our situation. It’s our own little act of “danuraba.” In the bathroom. Together.


Kate Darnton is a freelance writer.