Doctors Denounce School 'No Lice' Policies

By Henry H. Bernstein, D.O.
Content provided by the Faculty of the Harvard Medical School

Schools shouldn't force kids to stay home because they have head lice, a group of children's doctors says. The new guidelines on head lice are the first from the American Academy of Pediatrics since 2002. They take aim at schools that do not allow children who have head lice or nits to remain in school. Nits are the empty egg casings that get stuck to kids' hair at the roots. It makes no medical sense to keep kids at home if they have lice or nits, the doctors said. The risk of spreading lice in school is very small. The doctors also offered advice on treatment. Over-the-counter shampoos containing permethrin or pyrethrin are usually the first choice. But some lice can resist them. The guidelines explain other steps parents can take. These include washing bedding in hot water, putting stuffed animals in a sealed bag for a couple of weeks and using a fine-tooth comb to remove nits. Reuters Health news service and ABC news reported on the new guidelines. The journal Pediatrics published them July 26.

What Is the Doctor's Reaction?

Does your child scratch her head all the time? Are you worried she has head lice? Has it made you scratch your own scalp?

Do not panic! Head lice:

  • Are very common among young and school-aged children

  • Do not cause a disease

  • Are not a sign of bad hygiene

  • Can be tricky to treat

The American Academy of Pediatrics (AAP) has just come out with updated guidelines. They explain what lice are and how to treat them.

Head lice are small (about the size of a sesame seed). They are white, tan or light gray in color. They lay very small eggs on hair close to the scalp. Lice feed by sucking very small amounts of blood from the scalp. Their spit then makes the scalp feel itchy.

It is important to remember that head lice:

  • Move around by crawling

  • Cannot fly (or even hop)

  • Spread from person to person by head-to-head contact

  • May be spread by sharing personal items such as hair brushes and hats. This is rare because lice do not live for very long once they leave the scalp.

It is hard to find live lice on a child's head. Lice are small and crawl fast. It is easier to find their eggs that are very close to the scalp. People often misdiagnose head lice because they mistake these common things for live lice eggs:

  • Nits (dead egg leftovers, which can be around even without live lice)

  • Dandruff

  • Hair casts (dandruff that surrounds the hair in a cylinder shape)

  • Hairspray droplets

  • Scabs

  • Dirt

There are many ways to treat head lice. Each has different pros and cons. It is important to first make the correct diagnosis to prevent unnecessary treatment.

Treatments don't always work. Here are some of the reasons:

  • The diagnosis was wrong.

  • Treatment directions were not followed properly.

  • Not enough treatment product was used.

  • The child was exposed again.

  • The lice were resistant to the drug.

If a doctor believe the lice are resistant to an approved medicine, he or she can recommend another approved medicine or suggest other ways. Not all of these alternate methods have been fully studied.

This AAP report also talks about how schools should handle head lice. Kids with nits should not be kept out of school. This hurts their learning. Many kids have nits, but these are not live lice. Screening students does not do much good either and also is costly.

What Changes Can I Make Now?

Do not let lice drive you crazy! There is a pretty good chance that if you have kids, they will get head lice at some time. This is not your fault. It is not their fault. It just happens to lots of children from all neighborhoods.

Head lice are not dangerous. They can be pretty annoying, though. If you are worried about lice, keep these points in mind:

  • Check your child's head

    • If he or she is scratching the scalp a lot.

    • Before (and after) sleepovers and camps.

  • Do not panic if you suspect lice. You can always ask a trained person to look.

  • Check with the school nurse or your child's doctor for advice.

  • Do not keep your child out of school when classmates have lice. The risk of spread in the classroom is low.

If your child has head lice:

  • Talk about treatment options with your doctor.

  • Follow treatment instructions exactly.

  • Avoid head-to-head contact between your child and others.

  • Check all household members for lice.

  • Clean hair care items, bedding and clothing recently used by the child. Cleaning everything is not necessary since most lice do not live very long once they leave the scalp.

  • Consider nit removal.

  • Seek help if you are struggling with treatment or if your child seems to be infested a lot.

Make sure you do not:

  • Keep your child out of school

  • Treat your child with

    • Flammable or toxic substances (such as gasoline or kerosene)

    • Animal treatments (even if people tell you they have used them before)

  • Treat again unless your doctor says to do it

  • Dry-brush or blow-dry your child's hair. This can spread the lice to another person.

It is very important to remember that having lice is not a good reason for missing school. The AAP and most researchers agree that "no nit" policies in schools are pointless. These policies cause more harm than good.

Reference: Skin, Hair and Nails section on Better Medicine


Did You Know?

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True or false? Head lice can often be found behind the ears and at the hairline at the back of the scalp.