I would appreciate detailed information on how to treat head lice. My child is in year-round school. Last year, we battled head lice all year long. Over her last break we were able to get it under control. She just started another session and already we've had an outbreak. It has become a serious subject of concern among the parents at my daughter's school. What should we do? What are the latest recommendations? Is there anything that is not toxic that we can use?

As I picked up the chart in my inbox, I glanced down to see what the nurse had written. "Lice." Just looking at the word made my head itch.

Entering the exam room, I could tell that Mrs. X felt a bit uncomfortable.

"Hello, Mrs. X! How can I help you?"

"I can't believe it!" she said. "There's another outbreak of head lice at my kids' school and this time, my kids have been sent home."

Just listening to her made my head itch worse.

"Why can't they do something about it? Now we're stuck dealing with it, too! What can we do? I don't want to deal with this ever again!" she cried.

Mrs. X's feelings, and your feelings, are understandable and more common than you might expect. There are about 12 million cases of lice per year in the United States alone. Each year, many day-care centers, schools, neighborhoods, extended families, and small family units face this problem. You and Mrs. X are not alone.

Historically, the main method for getting rid of lice has been mechanical -- physically removing the nits, or "nit-picking," such as apes do for each other during their daily grooming routine. About 30 years ago, powerful pesticides were introduced as lice treatments. For a time these pesticides made treating lice much easier. Over the last several years, however, the lice have become increasingly resistant to these medicines. This resistance is growing. Now, once again, mechanical nit removal is the cornerstone of lice treatment, although the medicines can still be a real help.

The Great Lice Adventure

It is important for everyone potentially involved in an outbreak to be treated at the same time. If 99.99% of the lice are killed, but .01% are not, you already have the makings of another outbreak!

Here is a step-by-step guide for using common, over-the-counter medicines to kill the lice, followed by several great natural remedies:

• Set a community-wide time to act -- now!
• Get all the kids excited about The Great Lice Adventure! Have teachers do projects on lice as insects. The more the kids know about what's going on, the better. Use art, storytelling, science, even math. Start with one louse and calculate how many lice would be on an untreated head at the end of, say, a day, a week, a month ...
• Print detailed instructions on how to get rid of lice and distribute them to children, parents, teachers, and anyone else who works at the school.

Day One

Not all of the following steps are always necessary for an individual child. For stubborn cases, especially during school-wide outbreaks, following all of the steps can actually save a lot of hassle and repeated exposure to pesticides!

• Carefully comb through the hair using a nit comb. I don't recommend using the combs that come packaged with lice shampoos. Instead, use a new product, called the LiceMeister. Its metal teeth are very close together, catching lice well, but without catching or pulling on hair. Since most children will only sit still for a short time (and since most parents don't want to spend longer than necessary combing through lousy hair), using this comb results in a more thorough delousing than when using the ordinary plastic nit combs.
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