Should the student be excluded from school with live head lice or nits?
No. Guidelines: Evidence-based practices should be used in recommending treatment of this condition. Verbal and written instructions for treatment options should be given to the family of the student by the school nurse. The student should be allowed to remain in the classroom that day if comfortable and return to school the following day. School staff need to ensure student confidentiality is maintained and should not segregate or in any way embarrass the child. There is no research data that demonstrates that enforced exclusion policies are effective in reducing the transmission of lice.
Rationale: The management of pediculosis should proceed so as to not disrupt the education process. If a staff member suspects a student has head lice, they will discretely report this to the school nurse or principal. Following an assessment by the school nurse during a non-academic time period, if further action is necessary, the nurse will contact the child’s parent or guardian either by telephone or by a note sent home with the child at the end of the school day. The New Hampshire Department of Health and Human Services (NH DHHS) Pediculosis Fact Sheet is an appropriate handout to give parents.
Are no-nit policies or mass screenings recommended for schools?
No. Guidelines: There is consensus that no-nit policies are inappropriate in a school setting, according to the American Academy of Pediatrics, National Association of School Nurses, the CDC, and the NH Department of Health and Human Services. School–wide screenings and “no-nit” policies are strongly discouraged. Mass screening for live lice has not been proven to have a significant effect on the incidence of head lice in a school community over time. Manual removal of nits after treatment with a pediculcide is not necessary to prevent spread. (American Academy of Pediatrics Policy Statement on Pediculosis 2002, updated in 2009). Education of parents in identifying and managing head lice is the most helpful. We urge school districts to ensure that children do not miss class unnecessarily or encounter embarrassment and isolation, especially if they suffer from repeated head lice infestations. Parents should be encouraged to check their children’s heads for lice if the child is symptomatic and when close contacts have head lice.
Rationale: “No nit” policies contribute to the stigma created around lice. This over-emphasis on case-finding can lead to unproductive use of time by school staff and parents, missed classes, unnecessary absences, and parents missing work. Past screening and exclusion practices in schools have contributed to myths and stigma about lice, which are not supported by the current research, and have resulted in discrimination and unnecessary lost time from school. The importance of cooperation and open communication between families and schools is the most effective method of control!
What can be done to help student(s) with reoccurring head lice?
Guidelines: What may appear to be a reoccurrence of head lice may be the same initial infestation, which has not been treated properly. It is important that parents follow the exact directions on the product they are using and follow through on the indicated treatment regimen. Some of the treatments available are not 100% effective at killing head lice. If the parents suspect the treatment is not working, then they should seek the advice of a pharmacist or physician. Changing to another product with a different active ingredient could have improved results.
Rationale: Ensure the parents have an understanding of what head lice are, how they are spread, and the recommended methods for treatment of the child, other members of the household, and their home environment. The position statement on Pediculosis from the National Association of School Nurses (2004) states:
The school nurse is ideally suited to provide education and anticipatory guidance to the school community regarding best practices of pediculosis management. The school nurse’s goals are to contain infestation, provide appropriate health information for treatment and prevention, prevent overexposure to potentially hazardous chemicals, and minimize school absence.
The school nurse is a key person in modeling an appropriate professional approach to head lice management in a calm manner. The importance of cooperation and open communication between families and schools is the most effective method of control. In turn, parents will be able to focus on appropriate treatment without getting overly upset.
American Academy of Pediatrics Policy Statement on Pediculosis, 2002. A statement of reaffirmation for this policy was published on May 1, 2009. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;110/3/638
Harvey, Gerri. Twenty-One Surprising Things You Might Not Know about Head Lice. School Nurse Perspectives. www.gerriharvey.com
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