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Head lice during the school year and summer vacation affect an estimated 6 to 12 million children in the United States every year. Infestations can lead to itchy scalp, irritability and poor sleep.

Head lice populations in 25 states are resistant to the active ingredient in many over-the-counter treatments recommended by doctors and schools, scientists found in new research. Generally considered a nuisance because they don’t carry disease, lice can still be controlled using different chemicals found in prescription treatments.

Reports of lice resistance started appearing in the mid 1990s in the United States, Europe and Australia. A 2014 study suggested the potential for resistance is high in several areas in the United States and Canada. Among lice samples from 84 people in these countries, 99.6% of the insects had mutations in genes that could allow them to survive the insecticides permethrin and pyrethrin, which are the active ingredients in over-the-counter remedies.

Even if resistant lice are becoming more common, the infestations they cause are no worse than those of other head lice, except they can be harder to get rid of. “No one ever died of a head lice infestation,” said Frankowski, who is a spokesperson for the American Academy of Pediatrics and co-wrote its 2010 clinical report on head lice.

What should you do as a parent if your child has lice?

A strategy for getting rid of lice infestations is to brush the hair with a fine-tooth comb that pulls out the insects and sometimes even their eggs (called nits).

For children with straight, fairly short and manageable hair, this is the first thing that parents can try, Pollack said. “Get yourself a good lice comb, read the instructions and use it,” Pollack said. However, for children who have very thick or curly hair, it might be easier for parents to start by trying over-the-counter shampoos, he added.

What other options exist?

Licebeaters based in Long Island starts by looking for lice, and if it finds them, uses an olive oil solution that drowns the insects and makes them easier to comb out of the hair, Good said. Then specialists use their fingers to pick out the remaining nits. The service costs $250 an hour. “Some can do this themselves, but most people want help,” Good said.

If you happen to be in Oak Park, Illinois you can get the service for a very, very affordable price at Hair Butterflies Lice Removal Salon. Check out their services here.

She is an American entrepreneur, 5’ 2” with big hairy ideas and on a mission to extol the benefits of hair oil worldwide. She is also the co-owner of Obsessed Hair Oil along with her sister, Serena.