Head Lice: Evidence Based Management in the School Setting

Background

 
For many years, NSD had a policy of excluding students from school immediately upon finding head lice or nits and requiring complete nit removal before returning to school. Current evidence suggests that these requirements and other school measures such as vacuuming, spraying and undue concern about spread through shared school items is not warranted. The present procedure results in unnecessary absence from school, along with increased anxiety on the part of staff and parents.

For more then ten years reputable research from the Harvard School of Public Medicine, The American Academy of Pediatrics, The Center for Disease Control, The National School Nurses Association and others suggests practices that provide results based on scientific evidence and reduce unnecessary absences, limit embarrassment to students, decrease exposure to potentially toxic chemicals and calm undue anxiety on the part of parents and school staff.

"Excluding children from school with lice does not affect the total number of cases each year. Education of families on how to prevent and treat lice does affect the numbers in school" (American Academy of Pediatrics 2002).

What are Head Lice?

  • Head lice are small insects that can live on the scalp and neck of a human host. They do not live on animals.
  • They hatch from small eggs (nits) that are attached with a cement-like substance to the shaft of individual hairs.
  • They must have the warmth of the human body and blood on the scalp to survive.
  • They are NOT a health hazard, a sign of uncleanliness nor do they spread disease.
  • Head lice have "claws" that keep them attached to the hair and they swing from hair to hair like trapeze artists. They do not fly or jump. They want to STAY on the hair near the scalp.
  • They need very close head-to-head contact to spread from one person to another. Homes and camps are the most common mode of transmission.
  • Indirect transmission is uncommon but may occur via shared combs, brushes, hats and hair accessories that have been in contact with lice. RARELY are they spread through shared helmets or headsets.
  • Itching occurs when they inject a bit of saliva into the scalp, but itching can persist even after treatment and is not a reliable sign of lice.
  • When lice are discovered, they have usually been there about a month.

Basic Treatment (Parents may wish to consult with their physician or pharmacist)

  • Over the counter chemical treatments and combing out lice/nits OR
  • Mechanical removal (combing out lice and nits) AND
  • Cleaning bed linens and personal items that contacted the hair

Revised Head Lice Policy for Northshore School District

  • Students with nits only will be rechecked in 8-10 days. Parents are instructed to remove all nits.
  • Students found to have live lice; parent will be notified by phone and student may remain in school to the end of the day and a letter sent home regarding treatment.
  • To return to class students must present with evidence of adequate treatment (no lice and removal of most of the nits). Parents are asked to accompany the student to the office with the signed note stating what type of treatment was used.
  • Nurse may continue to provide follow-up checks.
  • The customary notification for the presence of head lice is to be done on an individual/case by case basis to the parent/guardian of an infested student. Classroom notifications are not done with typical head lice cases unless there are a high number of cases or other circumstances as determined by the school principal and school nurse. Schools will remind families to routinely check their students through out the year.
  • Entire classrooms will be screened when there are three cases in a 2-week period where the students are not in contact outside of class. (OSPI 2004)