In need of Nitty Nora

Headlice are rapidly climbing their way back into schools, prompting calls for the return of nit nurses, aka Nitty Noras. With a national campaign, a petition on the Number 10 website and massive online support, will the quest succeed?

8th January 2010, 12:00am

Nick Morrison

It was a ritual part of the school calendar, as much a fixture as the nativity play and sports day. Shuffling along, you queued up in the corridor until you were admitted to the inner sanctum, where you bowed your head and waited for judgment to be passed.

But the days when the school nurse would rifle through your hair on the hunt for headlice are long gone. The nit nurse - known as Nitty Nora to generations of children - was gradually phased out in the 1980s and 90s, regarded both as an inefficient way of screening and as degrading to those found harbouring the beasts.

Now, though, there are signs that headlice are on the advance again, increasingly resistant to the chemicals deployed against them. Although there are few reliable figures on the level of infestations, one study in Welsh primary schools showed the number of cases has doubled this decade.

A survey in Essex in 2003 found approximately one in 50 children had headlice, and almost four in 10 had caught them at some time in the previous 12 months. Even reality show contestants are not immune. It was reported last year that quiff-loving X Factor twins John and Edward had introduced headlice into the house they shared with their fellow contestants.

“Infestations are going up right across the developed world,” says Joanna Ibarra, of Community Hygiene Concern, a charity that promotes ways of tackling head lice. “Conventional insecticides are often simply not effective because the lice have become resistant.”

The apparent profusion of headlice has prompted calls for the return of Nitty Nora. A survey on the website netmums.com found almost 90 per cent support for the nit nurse to make a comeback, while a petition on the Number 10 website, running until May 18 this year, urges the Prime Minister to restore nit nurses in schools. Four previous petitions on the subject have collected between 189 and 383 signatories.

Lucy Weis’s introduction to headlice came when her eldest daughter caught them aged six. Attempts to vanquish the critters using special shampoos proved fruitless. “You buy all the lotions and use them but three or four lotions later you start thinking you can’t get rid of them,” she says.

Her frustration drove Mrs Weis, a mother-of-four from Colwyn Bay in north Wales, to launch the Nitty Nora campaign for the return of the nit nurse. She argues that even if parents manage to vanquish the bugs in their own child’s hair, there is a good chance they will be reinfested by classmates. It is only school-wide action, she says, that can banish them for good.

“Parents are happy to do it but because there is no co-ordination, they do their child’s hair and they go back into school and catch them again,” she says. “That is why we liked the nit nurse: she would come in and do everybody in the school.”

But she doesn’t envisage a return to the days of whole-school inspections. Rather than examining every child’s head in turn, the nit nurse should organise whole-school action against headlice, she says, as well as helping parents who struggle to deal with the problem.

In extreme cases, parents can be overwhelmed. Or sometimes don’t even try. A Norfolk mother was jailed for five months last year for neglect after her daughter’s hair was found to be crawling with lice. A social worker had thought the nine-year-old’s hair was dyed. Closer inspection revealed the “colour” was really thousands of headlice.

Headlice rarely pose a medical danger. The lice feed by sucking blood from their victim’s scalp. Their saliva can cause itching, but the biggest health risk is if repeated scratching makes the wounds bigger and opens them up to infection. Often of greater concern is the stigma carried by headlice. While the humiliation of being singled out by the nit nurse is, for now, consigned to the past, the shame of being portrayed as the source of an outbreak remains. And what is true for parents and their children is equally true for schools: no one wants to own up to having a problem.

One headteacher, speaking on condition the name of her school was withheld, says reports of headlice among pupils can be very alarming for parents. Her school, a primary in the north of England, gained unwelcome publicity last year when a parent contacted the local paper to claim her child had been given headlice by classmates.

The school’s PTA produced a guide for parents on how to get rid of the lice, but the damage had already been done. “Parents often find it degrading and when their child keeps getting it and they see no end to it, that is when it becomes frustrating,” the head says.

Her 30 years in education stretch back to the days when nit nurses were a common sight in schools, but she doesn’t believe they were effective in weeding out headlice. Rather than spending time checking every child’s head, school nurses these days are better employed focusing on issues such as child protection and obesity, she says. Instead, parents should take responsibility for regularly checking their child’s hair for lice, and taking remedial action if they are found.

Ros Godson, who represents school nurses for the union Unite, says blanket screening of school-aged children - including checking for headlice - was phased out because it was seen as inefficient. “Children used to have medicals as well, but this type of approach isn’t a good use of the school nurse’s time,” she says.

But the problem with putting the onus on the parent is that it only takes one to fail to perform their duty properly for a whole class to be reinfested. Mrs Weis, whose involvement in the Nitty Nora campaign has prompted neighbours to bring their children to her for delousing, says the flaw in this approach can make all a parent’s hard work in ridding their children of lice redundant.

And it’s not just the children. One poster on the TES Connect website, a primary school teacher, says she caught headlice three times last term. “Is there anything I can do to fend them off or must I resign myself to being infested until I retire?” she asks. Other posters recommend tying your hair back and keeping it away from the children as the most effective way of avoiding catching them.

The market for treatments to get rid of lice is worth about pound;30 million a year in the UK. But chemical lotions are only recommended when live lice have been spotted, as they are often ineffective against eggs. Combing using special nit combs is the other recognised method of lice removal.

Community Hygiene Concern developed its own Bug Buster kit, including wide and narrow-toothed combs, to combat lice. The charity also promotes National Bug Busting Days in schools, to encourage a synchronised effort to check for lice. The next Bug Busting Day is January 31.

This co-ordinated approach is proven to be the most effective way of eliminating headlice, says Ms Ibarra. It was pioneered on Teesside in the 1970s by the father of the current chief medical officer, Sir Liam Donaldson, when it halved the level of infestation.

One problem with the nit nurse approach is that when dry, lice will quickly move away from any disturbance in the hair. Wet lice, by contrast, tend to stay completely still. Checking the hair when it is wet therefore makes the lice easier to spot.

“The school nurse would miss all but the worst cases,” says Ms Ibarra. “They rely on being able to see lice on the head, but the lice rush away as the fingers move through the hair.”

Instead of nit nurses, schools should encourage parents to check their child’s hair when wet, and organise synchronised hair-checking to have the best chance of making sure re-infestations don’t occur, she says.

The majority of cases involve only about 10 lice and no itching, so many parents may be unaware their children even have lice. Regular checks where parents check their children will uncover even these “hidden” infestations.

“You might succeed in getting rid of the lice but if you are sending your child back into an environment where they are likely to catch lice again you could be none the wiser,” she says.

Some schools have turned to more drastic measures. Hairforce is a north London company that specialises in eradicating lice, through its team of “lice assassins”. Founder Dee Wright says they have been employed by a number of schools to deal with lice outbreaks.

Their approach is to carefully go through the hair with special combs. When called in by a school, five lice assassins go in to check every child’s hair thoroughly, before informing the school of whether it has a light, medium or heavy infestation.

“Checking every child can be really useful in letting a school know what is going on, but it would be very hard for one nurse to be able to do that in a school of 250 children,” Ms Wright says. “We might be there for a day and a half and school nurses don’t really have the time to do that.”

Recent cases treated by Hairforce include a boy who had about 450 adult lice on his head, and a girl who had been infested for six years. The Hairforce method, which costs pound;120 per child per treatment, involves three separate appointments over a period of several weeks, and guarantees to remove all lice.

But there can never be a guarantee they won’t come back through contact with another infested head. Only a concerted campaign of vigilance can hope to keep the lice at bay, and in the continued absence of the nit nurse, it looks like it’s up to schools to ensure parents get on board. Perhaps it’s time to take the stigma out of the louse and show the critter we mean business.

Nitty Nora campaign: www.nitworks.co.uk ; Hairforce: www.thehairforce.co.uk

Bug Busting kits cost pound;5.95 plus postage and packing from www.nits.net or the Community Hygiene Concern helpline 01908 561928