Head lice: What school leaders need to know
On Board Online • February 6 2017
By Krista Lauer, M.D.
No school leader or parent wants to get the dreaded news that head lice are affecting students. People fear head lice more than spiders, bed bugs and even serious health concerns like Lyme disease and influenza.
It is unfortunate that something so tiny (an adult head louse is 2-3 millimeters in size) generates such a disproportionate amount of fear. Myths and misconceptions seem omnipresent in conversations about head lice.
Here is some information to ensure your school policies are based on facts, not fear.
How common are cases of head lice?
It is estimated that there are 6 to 12 million new cases of head lice diagnosed in children ages 3 to 11 each year. This often results in school absences, lost time from work for parents or caregivers, and social isolation for the affected child and their extended family.
Are head lice a serious health threat?
No. Head lice do not transmit infections and they are not a communicable disease.
How do infestations occur?
First, let's bust the myth involving transmission through inanimate objects such as combs, brushes, hats, headphones or helmets. That's possible, but rare. Hatched lice (the singular is louse) feed on blood, and they cannot survive off the scalp for more than two days. In the vast majority of cases involving children, transmission occurs after they touch each other (particularly head-to-head contact) when interacting at sleepovers, play dates, etc. If a child has head lice, family members and people who share a bed should be checked. But there is no basis to treat a person's environment such as car seats or stuffed toys.
Do infestations of head lice coincide with bad hygiene?
Another myth! The truth is that an infestation has nothing to do with personal hygiene. Head lice do not discriminate. Infestations can be found in all socioeconomic groups. They affect men, women, boys and girls.
What is the life cycle of a louse?
A louse begins as an egg or nit. About a millimeter long, it attaches itself firmly to an individual hair strand close to the scalp. After 7 to 10 days, the nit hatches and becomes a nymph and begins to feed on blood if it is close enough to the scalp. In the next nine to 12 days, the nymph matures into an adult louse, which can lay eggs. Mature lice can live about three to four weeks.
Should children with head lice be prevented from attending school?
No, for three reasons. First, it is not uncommon for a child to be misdiagnosed as having lice. Dandruff and hair products are frequently misidentified as lice. Second, by the time a child is found to have a head lice infestation, peers have already been exposed; keeping the child home is pointless. Finally, there is no evidence that keeping a child with nits or lice out of school prevents other children from becoming infested.
What do relevant medical organizations have to say?
The American Academy of Pediatrics (AAP) updated its recommendations in 2010 and suggested that schools adopt a "do not exclude" policy. The following year, the National Association of School Nurses (NASN) followed suit. It is now recommended that children not be sent home if they have lice eggs (nits) and even if they have live lice. (Editor's note: NYSSBA's Policy Services team recommends districts follow the NASN recommendations. However, affirmatively adopting a "do not exclude" policy is not necessary. Just don't have an "exclude" policy.)
What's wrong with having a "no nit" policy?
A "no nit" policy means that children are not allowed to return to school or the classroom until they have no remaining evidence of infestation, which isolates them and deprives them of learning opportunities. Although such policies are common, they have no basis in science or medicine and create many problems. First, such policies set parents on a quest to remove nits, and it's a fool's errand; nits are firmly cemented to the hair shaft and are not easily dislodged. Second, the mere presence of nits does not indicate active infestation; only nits that are located a half an inch or less from the scalp are likely to be viable. Third, there is no way to tell, using the naked eye, if a nit is viable or dead.
What are "super lice"?
At a widely publicized paper presented at the 2015 conference of the American Chemical Society, researcher Kyong Yoon of Southern Illinois University reported that lice populations in at least 25 states had developed resistance to permethrin, an insecticide in many over-the-counter treatments as well as chemical cousins called pyrethroids. He tested lice for a trio of genetic mutations known collectively as kdr, which stands for "knock-down resistance." Samples from New York State all had at least one of the mutations.
Should students be permitted to not wear helmets during sporting activities based on concerns about contracting head lice?
Absolutely not! Unlike a head lice infestation, a head injury or concussion presents a serious health risk and has the potential for far-reaching, long-term health implications. Wearing protective helmets or equipment during a sports activity should never be discouraged due to fear of head lice infestation.
What should we tell children to do - or not do - to avoid head lice?
To minimize chances of becoming infested with head lice, children should avoid head-to-head contact during play or social interaction. However, in the age of selfies, this is challenging.
What should we tell parents about head lice?
Communicate with students' families about head lice. Emphasize that head lice do not cause disease and do not pose a medical threat. Let them know your district's policies on handling head lice. Parents should know that if their child becomes infested, it is a sure sign that a child is engaged socially. In other words, the child has friends!
Dr. Krista Lauer is medical director of Lice Clinics of America. Owners of about 140 Lice Clinics in the U.S. (including Buffalo, Rochester, Syracuse and Hudson Valley) use a FDA-cleared medical device called AirAll‚ to kill lice and eggs by dehydrating them with heated air. Lice Clinics of America and AirAll‚ are brands owned by Larada Sciences, Inc.
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