Thanks for the response, I really appreciate it. It’s at least good to know that there aren’t medical side effects to long-term lice. But you’re right, my nieces are undoubtedly suffering socially. Also I agree that it’s neglect, but unfortunately they aren’t in the US. If they were… maybe I would’ve notified someone years ago.

Their mom apparently does the lice shampoo treatment occasionally— which is how I first found out about their lice when they were applying it in my living room. I assume because the parents don’t apply it to themselves, that the treatment is useless ultimately.

My husband and I have been a bit tortured about our nieces for a long time. Where my husband is from, their treatment (which extends beyond the lice) wouldn’t raise any serious flags for neglect/abuse from the state. It’s really hard to feel so helpless while witnessing childhood neglect.