Pediculosis Humanus Capitis, commonly known as head lice, is a common parasitic infestation affecting all ages, races, genders, and socioeconomic levels. It affects six to twelve million people a year and is most prevalent in young girls between the ages of
four and ten. Literature reveals that head lice are the second most common childhood health condition, second only to the common cold1. Most distressing though, parents of school-aged children rank head lice as a more important concern than some more serious
health conditions. The facts show head lice to be more of a social issue than a serious health concern.
The following are recommended as best practices:
Brief Overview of Head Lice2
Head lice are tiny parasitic insects that live, feed and breed only on the human head. They do not live on animals or birds and cannot survive for more than 48 hours off of the human head. The female head louse lays eggs (nits) in the hair, glued tightly to the hair shaft. An infestation of head lice can be symptom free and go undetected for several weeks. Symptoms may include itching, redness and scratch marks. Severe untreated infestations can lead to secondary infections caused by bacteria. Head lice themselves do not carry or transmit any diseases.
Head lice are primarily transmitted by direct head to head contact. An example of this would be siblings sharing the same bed and pillow. This contact forms a handy bridge for the head lice to cross over from one person to another. Hugging and cuddling are also forms of direct contact. Other forms of transmission are less direct, such as sharing of hairbrushes, combs, barrettes, hats, scarves, etc. One important thing to remember is that head lice are “obligate human parasites”. They want to stay on the same host throughout their life cycle. An infestation of head lice can bring on a wide range of emotional responses ranging from embarrassment to guilt to rage. Parents and caregivers can experience much frustration that can lead to anger and blame, especially to the school. For the school-aged child, an infestation with head lice can cause excessive absenteeism. For the caregivers, it can cause lost time in the workplace and lost wages. Schools are impacted by increased
staff time spent in screening for head lice, calling parents and other related matters that infringe on their usual duties. Current research indicates that most lice infestations are not contracted in the school setting.
Treatment is a three step process.3, 4
Head Lice in the School Setting
Although head lice are transmissible, their potential for epidemic spread in the school setting is minimal. Thus major health organizations such as the American Academy of Pediatrics, the Harvard School of Public Health, and the American Public Health Association have recommended against excluding children from school as an intervention against head lice infestation. From a medical perspective, infestation with head lice is a mild health condition without serious health consequences for a child, and should not be considered a major health threat to those infected or those potentially exposed. No convincing data exists that demonstrates that enforced exclusion policies are effective in reducing the transmission of lice. One study executed and reported by L. Keoki Williams, MD in Lice, Nits and School Policy is illustrative. This study involved
screening 2,094 children in Atlanta schools. The researchers found that 74 (3.6%) of the children screened had nits but no live lice. Live lice subsequently appeared in only 9 of the children with nits. This study shows that the likelihood that nits will develop into an infestation with live lice is low. It also suggests that excluding all children with nits from school and requesting they be treated for lice is a “shotgun” approach. For each child and family who could actually benefit from such an approach, several children and their families will experience unnecessary pesticide exposure and lost school and work days. Other research, done by Dr. Richard Pollack at the Harvard School of Public Health, highlighted the following three points regarding the diagnosis and management of head lice infestations:
Recommended Head Lice Procedures in a School Setting
The following guidelines will assist in the prevention and spread of head lice:
C. Building Prevention
Students with Head Lice
Students with live lice will be excluded from school. Although uncommon, transmission of live lice can occur between pupils at school. Exclusion from school in this circumstance is an almost universal practice in the United States. Parents should be advised to return to school with the student for re-admittance. It may be necessary to further exclude a student when they attempt to return to school if live lice remain present.
The following statements are recommended guidelines for readmission to school:
All checks for head lice will be done in a confidential manner to respect the student’s right to privacy, and to the extent possible, to avoid embarrassment. Staff members are never to discuss an infestation among themselves, in the presence of other students or out in the community. Furthermore, staff members are to defer to the professional expertise of the school nurse concerning matters of exclusion and readmission of students with lice infestations.
Designated School Staff
It is desirable to have a school nurse responsible for lice identification. In the school nurses’ absence, the clinic assistant will check for lice. Consistent and standardized instruction should be given with frequent updates and reviews to avoid inaccurate positive results and possible over treatment. Treatment strategies must only be offered by school health professionals.
Health education and outreach to de-stigmatize Pediculosis in our community is strongly recommended and supported. The above guidelines are intended to help our school nurses make fair and consistent decisions relevant to our county’s population and its resources. These guidelines include a no-lice policy and a limited no-nit policy as outlined above.
1 Hansen, Ronald MD, et.Al Guidelines for the Treatment of Resistant Pediculosis, Contemporary Pediatrics, 2000(Supplement).
2 Pollack, Richard J., “Head Lice: Information and Frequently Asked Questions”, Department of Immunology and Infectious Disease, Harvard School of Public Health.
3 Pray, Steven W., “Head Lice: Perfectly Adapted Human Predators”, American Journal of Pharmaceutical Education 8/4/99.
4 Got Head Lice? Get Advice!, Head Lice Resource Team, Multnomah County Health Department and Multnomah Education Service District, 2001.
5 Quality Nursing Interventions in the School Setting: Procedures, Models and Guidelines, Multnomah Education Service District, Fifth Edition, 1996.
1. Pollack, Richard J., “Head Lice: Information and Frequently Asked Questions”, Department of Immunology and Infectious Disease, Harvard School of Public Health.
2. Hansen, Ronald MD, et. Al. Guidelines for the Treatment of Resistant Pediculosis, Contemporary Pediatrics, 2000(Supplement).
3. National Association of School Nurses, Position Statement.
4. ABC’s of Safe and Health Child Care, A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service Centers for Disease Control and Prevention, 1996.
5. Head Lice Infestations: a persistent itchy “pest”, Infectious Diseases and Immunization Committee, Canadian Paediatric Society, 1996.
6. The No Nit Standard, A Healthy Standard for Children and their Families, National Pediculosis Association.
7. Dealing with Head Lice: A Practical Approach for Schools, Parents, and Communities, Public Information Office and Bureau of Epidemiology and Disease, Kansas Department of Health and Education.
8. Williams, Keoki L., Lice, Nits and School Policy. Pediatrics, Vol 107 No. 5 May 2001.
9. Recommended Guidelines for the Management of Pediculosis in School Settings, School Health Program, Bureau of Children’s Health, Texas Department of Health, April 2001.
10. Quality Nursing Interventions in the School Setting: Procedures, Models and Guidelines, Multnomah Education Service District, Fifth Edition, 1996.
11. Springfield Public Schools, Communicable Diseases Head Lice Treatment, procedure JHCCAR.
12. Dillenburg, Jack MPH, Head Lice: The Myth, The Facts, The Update. LA County Department of Health Services, June, 1999.
13. Roberts, Richard J., Head Lice, New England Journal of Medicine Vol. 346, No. 21, May 23, 2002.
14. Prey, Steven W., “Head Lice: Perfectly Adapted Human Predators, American Journal of Pharmaceutical Education, Aug., 1999.
15. Got Head Lice? Get Advice!, Head Lice Resource Team, Multnomah County Health Department and Multnomah Education Service District.
16. “Pediculosis Statement”. Head Lice Resource Team. Multnomah County Health Department and Multnomah Education Service District.