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The Great Lice Debate

Responses are provided by Deborah J. Pontius, MSN, RN, NCSN, FNASN, health services coordinator and school nurse, Pershing County School District, Lovelock, NV; and executive committee member and past board member, National Association of School Nurses (NASN).

Q: What are your top three head lice prevention tips?

A: Parents often ask me this question after they have personally dealt with head lice, wondering if they could have done anything more to avoid it. While no prevention method is guaranteed to completely ward off head lice, according to the Centers for Disease Control and Prevention (CDC), the following steps can be taken to help prevent and control the spread of head lice:

    • Avoid head-to-head contact during play time and other common activities such as sports practice, sleepovers, camp, etc.1shutterstock_588954527
    • It’s a good idea not to share hats, scarves, combs, brushes, towels, coats or any hair accessories in general, particularly those that come into contact with a person with head lice.1
    • Don’t lie on carpets, beds, couches, pillows or stuffed animals that have recently been in contact with a person with head lice.1

Many parents also believe that homeopathic remedies, such as using essential oils, prevent and treat head lice. When choosing treatment options, it is best to consider evidence-based, FDA-approved solutions that have been tested by professionals and have been proven effective for eliminating head lice.

Most importantly, if you find yourself in a battle against head lice, stay calm and don’t panic. Many of your friends and even extended family members have likely also dealt with head lice, so try to keep from feeling embarrassed, ashamed or even isolated. Instead talk to your health care professional about the best treatment options for your family, which may include prescription options.

Q: What is the biggest myth about lice?

A: In my day-to-day interactions with students, parents, teachers and administrators as a school health services coordinator, I see and hear a lot of misconceptions surrounding head lice. But one of the myths that I’m most passionate about debunking, and that is often perpetuated, is that no-nit policies reduce the transmission of head lice in schools, which no evidence has shown.2

Traditionally, many schools have had a “no-nit” policy, requiring all viable and non-viable nits (or head lice eggs) be removed before a child can return to school. This policy is problematic for many reasons – removing a child from school can contribute to the stigma and shame that is often associated with contracting head lice. Not to mention:

      • Approximately 10 percent of school-aged children in the United States have experienced long-term consequences of school absences due to “no-nit” policies prohibiting them from attending school because of head lice or nits.4 For example, 12-24 million school days are missed annually, often causing students to fall behind in class.5
      • Families can lose up to $2,720 in wages per head lice infestation.2

The American Academy of Pediatrics (AAP),6 CDC7 and the National Association for School Nurses (NASN)8 have all called for an end to “no-nit” policies in schools. Additionally, many parents may find it surprising to learn that schools provide little to no opportunity for close head-to-head contact, excluding preschool and kindergarten-aged children, making them a rare source for head lice transmission.2 It’s important, however, that despite where your school district stands on this policy, parents remain vigilant about treating head lice.

Q: What is a nit?

A: There are three stages of a louse life cycle: egg/nit, nymph and adult.9 Adult female head lice lay 8 to 10 eggs, also known as nits, per day.2 Typically white or yellowish in color, nits are often confused with scabs, dandruff, or droplets of hair spray.9 Nits are most commonly found behind the ears or at the nape of the neck.2 Parents should also know that not all nits will hatch and become live head lice.9 Nits that are located further than ¼ inch from the base of the hair shaft may be empty, have already hatched or are considered non-viable.9

Q: How can you really get rid of lice?

A: The CDC recommends treatment for head lice if someone is diagnosed with a live case.10 When parents come into my office panicked after discovering their child may have head lice, my advice is to stay calm and consult a health care provider who can confirm the diagnosis and discuss the best treatment options for your family.

Furthermore, while head lice is most commonly transmitted by head-to-head contact,9 parents should combine treatment with adjunctive cleaning measures: dry-clean or wash in hot water recently-worn clothing, hats, used bedding and towels, and soak personal care items – such as combs, brushes and hair clips – of all family members with head lice.10 For items that cannot be washed, seal them in a plastic bag for two weeks.10

Q: Why are people so grossed out by lice?

A: I’m well aware that the topic of head lice alone is enough to make people start itching! And after 17 years as a school nurse, I’ve seen a lot of cases of head lice, as well as many different reactions to the news.

I think the visceral, negative reactions to head lice are often because of the abundance of misinformation on the internet and common myths that beg to be debunked. It is always important to fact-check and make sure that what you read comes from a credible source or a medical professional. I encourage parents and caregivers with school-aged kids to talk to school nurses, pediatricians and other health care professionals about the condition before your child has it so you know what to expect and afterwards to ensure an accurate diagnosis and the best treatment. There’s also a host of information from trusted, credible medical organizations like AAP, NASN and the CDC.

Q: Should a child go to school or daycare if they have lice?

A: Yes, it is okay for your child to stay in school or daycare if they have head lice, unless there are explicit policies in place against head lice in the classroom. If you are unsure of the head lice policy, contact your school nurse or administrators who will have the latest information.

If there is a “no-nit” policy in place, do not give up hope! Partner with your school nurse to advocate for school board administrators to reassess their approach to head lice with the latest, evidence-based information. That can incite change so kids and their families feel less shame from head lice stigma, fewer kids are removed from school unnecessarily and parents are able to stay at work to provide for their families.

Q: Anything else parents and caregivers should know?

A: While head lice is a common childhood event, parents can often mistake what is and what isn’t active head lice. I remember one mother who came to see me and was quite upset. She was certain her child had head lice again after having seen nits on her head and was convinced it was from school, as that was the only place the child had been. I took a look at the child’s head and realized the problem. The mom pointed to nits found 2 and 3 inches down the hair shaft. These were very old nits from the previous infestation 4-6 months ago. Instead of live nits, these were just old, empty shells that hadn’t fallen out with the hair or been removed. It’s a reminder for parents that not everything on the head is an active case of head lice, and that’s why it’s always a good idea to visit a health care provider if you think your child has an infestation.

Also when dealing with a head lice infestation, remember that you are not alone. Since head lice are only spread from close head-to-head contact,9 I often tell my families something noted parasitologist and lice specialist Dr. Richard Pollack says, “Be happy! Having lice means your child has friends!” Your children are not dirty, and they are not bad. They are just kids with families and friends, all of whom can spread colds, the flu and yes, even head lice.

Lastly, we’ve learned a lot about head lice in the last few decades, and there have been many advancements in treatment. Together, parents, caregivers, administrators and school nurses can all effectively advocate for change in outdated, ineffective no-nit policies, educate one another on the facts of head lice and keep our children happy, healthy and in school.




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