Lice Work, If You Can Get It

Alternative remedies, such as the natural oils that Franco recommends, are largely unproven. Some experts also caution that such products don't have to meet Food and Drug Administration safety standards.

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"There's not a body of evidence out there that would satisfy scrutiny that the stuff is efficacious or safe," says Harvard's Pollack.

He recommends parents start with an over-the-counter treatment and use it as recommended. If that doesn't work, he advises a prescription product that contains a different insecticide, because "resistance to one insecticide doesn't necessarily mean resistance to another."

Pollack warns that misdiagnoses and mismanagement of lice infestations are common. The maniacal household cleaning such as that recommended by Franco is overkill, he says. Pollack also wants to dispel the notion that head lice are associated with filth, poor parenting or poor housekeeping.

"Lice don't give a damn," he says. "First, they want human blood. Second, they need a way to gain purchase to their favorite spot, the head hair. They don't care how many times a day you vacuum."

So, is hiring a nitpicker worth your while?

Koehler says it could be, depending on skill and speed. "The kids don't want to sit still for long." Pollack is skeptical.

"If people have the financial sources and desire to hire people to do this, fine," he says, adding, "I'm not convinced that some of these nitpickers know what they are doing or are successful."

Franco shrugs off the criticism. Her clients recognize, she says, that bringing in an outsider can help ease the tension that can seize a household after an outbreak. "Sometimes your kids are more receptive to an adult who is not Mom," she says.

And once she's on the case, she adds, she's confident the critters won't get away. "At a certain point, there's nowhere left to run. I can anticipate where they are going to go." ¿

Elizabeth Agnvall is a frequent contributor to the Health section. Comments:health@washpost.com.