MANAGING HEAD LICE IN THE SCHOOL SETTING

Report
A presentation for teachers and parents
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The objective of this presentation is to provide
current research based information about head lice
and how to manage children with lice in the school
setting.
At the conclusion of this presentation the learner
will:
Understand what head lice are and how they are
transmitted
Understand the rationale for the recommendations
to not exclude children with lice from school
Understand the general principles of prevention
and treatment
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First and foremost it must be acknowledged that when
we hear the word “lice” we immediately have the “icky
reaction”.
Parents and teachers alike have a tendency to react with
great alarm, if not panic, when they hear that they have
a child at home or in their classroom who has lice.
In the past, children with lice have been banished from
school and advised not to return until they are “nit free”.
Parents have gone to great lengths to rid their child of
lice- even resorting to calling a 24 hour hotline and using
untested home remedies
School nurses have spent precious time doing classroom
“lice checks” and subsequently sending children home
who are found to have lice.
The head louse, or Pediculus humanus capitis, is a
parasitic insect that can be found on the head,
eyebrows, and eyelashes of people
 Head lice are small, wingless insects which feed on
human blood and live close to the scalp
 They need human blood in order to survive
 Head lice that are off of their human hosts will
starve
 It is generally believed that a head louse will not
survive for more than 24 hours when off of its
human host
 Head lice are not known to spread disease
 Head lice do not thrive on pets
http://www.cdc.gov/parasites/lice/head/schools.ht
ml
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Live lice lay eggs, these are called nits- you can not catch
nits- they need to be laid by live lice
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Nits are small yellowish-white (pearly) and oval shaped
and are glued to the hair shaft at an angle
 Once laid, it takes 7-10 days for a nit to hatch, and
another 7-10 days for the female to mature and begin
laying her own eggs
 Head lice are clear in color when hatched, then quickly
develop a reddish-brown color after feeding
 Head lice are about the size of sesame seeds
 Head lice have six legs equipped with claws to grasp the
hair
 Head lice live for approximately 30 days on a host and a
female louse may lay up to 100 nits (eggs).
http://www.cdc.gov/parasites/lice/head/biology.html
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The presence of lice is usually detected by the presence of
adult live lice, or nits (eggs) attached to the hair shaft
Nits are often at the nape of the neck and behind the ears
Complications of infestations are rare and involve bacterial
skin infections caused by scratching and subsequent
introduction of bacteria normally found on a person’s skin
Itching is the most common symptom of a lice infestation,
along with the following additional symptoms:
a tickling feeling or a sensation of something moving in the hair
irritability and sleeplessness
sores on the head caused by scratching
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Head lice have been around for thousands
of years, evidence of infestations have been
found in ancient Egyptian tombs
All children are at risk for head lice
Having lice has nothing to do with hygiene,
income, or any other factors except that
children are social beings and are therefore
at higher risk for getting head lice
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Lice spread through direct contact
They cannot jump or fly – they crawl
The most common cause of infestation is direct
head-head contact with an already infected person
Lice can survive for short periods on clothing, hats,
hairbrushes, scarves, coats, sports uniforms,
bedding, couches, carpeting, pillows, stuffed
animals etc. so these can be involved in the spread
Dogs, cats, and other pets do not play a role in the
spread of head lice
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Screening for lice has not been proven to have a significant
effect on the spread of head lice in a school community
In addition such screening has not been shown to be costeffective
Children who are found to have lice eggs (nits) or live lice
have most likely been infected for days if not weeks
The AAP recommends that healthy child should not be
excluded from or miss school because of head lice, and nonit policies for return to school should be abandoned.
See more at: http://www.aap.org/en-us/about-the-aap/aappress-room/pages/AAP-Offers-Updated-Guidance-onTreating-Head-Lice.aspx#sthash.6LqMzoIP.dpuf
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It is the position of the National Association of School Nurses
that the management of head lice should not disrupt the
educational process.
No disease is associated with head lice, and in‐school
transmission is considered rare
When transmission occurs, it is generally found among younger
aged children with increased head‐to‐head contact
Children found with live head lice should remain in class, but
be discouraged from close direct head contact with others
http://www.nasn.org/Portals/0/positions/2011pspediculosis.pdf
“Lice are not particularly contagious, they hurt
basically no one, and they’re not a public health
risk. Lice don’t actually matter”.
Dan Kois, senior editor at Slate and a contributing writer to
the New York Times Magazine.
http://www.slate.com/articles/life/family/2014/03/lice_in_sch
ool_let_em_stay.html?wpisrc=burger_bar
It is recommended that you consult a health care
provider about treatment
 Treatment for head lice is recommended for
persons with an active infestation
 All household members and other close contacts
should be checked; those persons with evidence of
an active infestation should be treated
 Some experts believe prophylactic treatment is
prudent for persons who share the same bed with
actively-infested individuals.
 All infested persons (household members and close
contacts) and their bedmates should be treated at
the same time
http://www.cdc.gov/parasites/lice/head/treatment.
html
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Treatment for head lice usually consists of shampooing
the hair with a medicated shampoo containing one of
the following ingredients: permethrin, pyrethrin,
malathion, benzyl alcohol, spinosad, or ivermectin.
Shampoos containing lindane are no longer
recommended.
Hair should be checked daily for the 10 days following
treatment for newly hatched head lice. If these are
present, an additional treatment may be necessary.
Many of these agents require a reapplication of the
treatment 7-10 days later to kill immature lice that may
have hatched from eggs that were not inactivated
during the initial treatment
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Before shampooing remove clothing that can
become wet or stained during treatment
Apply lice shampoo, also called pediculicide,
according to the instructions contained in the
box or printed on the label.
If the infested person has very long hair (longer
than shoulder length), it may be necessary to
use a second bottle. Pay special attention to
instructions on the label or in the box regarding
how long the medication should be left on the
hair and how it should be washed out.
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Machine wash and dry clothing, bed linens, and
other items that an infested person wore or used
during the 2 days before treatment using the hot
water (130°F) laundry cycle and the high heat
drying cycle.
Clothing and items that are not washable can be
dry-cleaned or sealed in a plastic bag and stored
for 2 weeks
Vacuum the floor and furniture, particularly where
the infested person sat or lay
Do not use fumigant sprays or fogs; they are not
necessary to control head lice and can be toxic if
inhaled or absorbed through the skin
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Avoid head-to-head (hair-to-hair) contact during play
and other activities at home, school, and elsewhere
(sports activities, playground, slumber parties, camp)
Do not share clothing such as hats, scarves, coats, sports
uniforms, hair ribbons, or barrettes
Do not share combs, brushes, or towels. Disinfest combs
and brushes used by an infested person by soaking them
in hot water (at least 130°F) for 5–10 minutes
Do not lie on beds, couches, pillows, carpets, or stuffed
animals that have recently been in contact with an
infested person
http://www.cdc.gov/parasites/lice/head/prevent.html
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Routine screening is not cost effective and has
not proven to have a significant effect on the
spread of head lice in a school community over
time
No child should unnecessarily miss time from
learning
No healthy child should be excluded from or
allowed to miss school time because of head
lice
A No-nit policy for return to school should be
abandoned
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Andresen, K. & McCarthy, A. (2009). A policy
change strategy for head lice management. The
Journal of School Nursing, 25(6), 407-416.
Gordon, S.(2007). Shared vulnerability: A theory
of caring for children with persistent head lice. The
Journal of School Nursing, 23(5), 283-292.
Pontius, D. (2011). Hats off to success: Changing
head lice policy. NASN School Nurse, 26(6), 356362.
Weisberg, L. (2009). The goal of evidence-based
pediatric guidelines. NASN School Nurse, 24(4),
165-166.
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http://pediatrics.aappublications.org/content/12
6/2/392.full?sid=d84bd3b5-304f-4b8e-bf40be2c7c1a35cb
http://www.slate.com/articles/life/family/2014/
03/lice_in_school_let_em_stay.html?wpisrc=burge
r_bar
http://www.nasn.org/PolicyAdvocacy/PositionP
apersandReports/NASNPositionStatementsFullVi
ew/tabid/462/ArticleId/40/PediculosisManagement-in-the-School-Setting-Revised-2011
http://www.cdc.gov/parasites/lice/head/school
s.html
http://www.bostonglobe.com/lifestyle/health
-wellness/2013/11/18/school-head-licepolicies-needupdate/WeTYItmzgaPwNB2W4a6bmK/story.
html
The National Association of School Nurses has
many resources including handouts for
teachers and parents
 http://www.nasn.org/toolsresources/headlice
pediculosiscapitis/licelessons
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