LICE

Stephanie Martin, RN, BSN, PHN
District Nurse

What are head lice?
Head lice are small insects found in the hair. Adult head lice are grey or brown, wingless insects approximately 1/8 inch in length. Lice do not have jointed bodies, hind legs or wings, which makes it impossible for them to jump or fly. The adult females lay eggs (called nits). The nits are attached like glue to strands of hair near the scalp.

The California Department of Public Health states, “Head lice, while a significant social problem, do not transmit disease to humans.”

The Centers for Disease Control and Prevention state, “Head lice can be a nuisance but they have not been shown to spread disease.”

Symptoms
The Centers for Disease Control and Prevention state the following symptoms: Head lice infestations can be asymptomatic, particularly with a first infestation or when an infestation is light. Itching ("pruritus") is the most common symptom of head lice infestation and is caused by an allergic reaction to louse bites. It may take 4-6 weeks for itching to appear the first time a person has head lice. Other symptoms may include: a tickling feeling or a sensation of something moving in the hair, irritability and sleeplessness, and sores on the head caused by scratching. These sores caused by scratching can sometimes become infected with bacteria normally found on a person’s skin.

Detection
Lice can be hard to see. A bright light and magnifying glass can help. Part your child’s hair in to small sections and look for crawling lice or nits. Nits are easier to see than lice because nits are attached to the hair strands and do not move. Nits are tiny, white, oval shaped eggs that are attached to the hair near the scalp. Dandruff is often times confused as nits. Dandruff will flake off easily, while nits are not removed easily.

The Centers for Disease Control and Prevention recommend the following: You should examine your child's head, especially behind the ears and at the nape of the neck, for crawling lice and nits if your child exhibits symptoms of a head lice infestation. If crawling lice or nits are found, all household members should be examined for crawling lice and nits every 2-3 days. Persons with live (crawling) lice or nits within ¼ inch or less of the scalp should be treated.

Transmission
Head to head contact is the most common form of transmission; however lice can be transmitted by sharing items such as combs, hats, clothing, barrettes, helmets, scarves, headphones, or other personal items.

Recommended Treatment
The California Department of Public Health recommends a single treatment with one of the following treatments, then reapplication if live lice are found seven to ten days later. Nit combing is also recommended. Combing and removal of nits may help to reduce the duration of the infestation.

Over The Counter

  • Permethrin (i.e. Nix®*) andpyrethrin treatments

  • The Lousebuster®* (a device designed to deliver heated air at high flow to the scalp and hair to kill lice and nits)

Prescription

  • Benzyl Alcohol Lotion 5% (Ulesfia®*)

  • Malathion 0.5% (Ovide®*)

  • Spinosad 0.9% (Natroba ®*)

  • Ivermectin 0.5% (Sklice®*)

*Use of this product name does not imply commercial endorsement by the California Department of Public Health.

Other treatments:
The California Department of Public Health states:

“There is no conclusive scientific evidence to support the use of products such as vinegar, isopropyl alcohol, enzyme-based compounds, tea tree oil, or other alternative products advertised to dissolve the glue on the nits (to ease their removal) or kill the nits. Similarly, there are no conclusive scientific data to support claims that mayonnaise, olive oil, melted butter, petroleum jelly, or other alternative products on the hair “suffocate” the nits and lice. Drowning lice is also an ineffective way to kill lice. Natural products (i.e. herbal products) are not regulated for safety by the U.S. Food and Drug Administration.”

Nit Combing
Nit combs should be metal and have long teeth. Several brands are available at your local pharmacy. To nit comb your child’s hair, start by parting your child’s damp hair in to small sections and securing the sections with hair clips or hair ties. Work with one section at a time. Run the nit comb through the hair starting at the scalp and moving down the hair to the ends. Rinse the nit comb in a glass of water or wipe it clean with a tissue when there are nits or lice on the nit comb (before running it back through the hair). Fanning the teeth of the nit comb while in a glass of water helps to remove the nits and lice from the nit comb. Keep combing through the sectioned hair in this manner until you no longer see nits or bugs on the nit comb. Continue nit combing section by section until you have finished all sections. Once you have completed nit combing all sections, part your child’s hair in to small sections again. Remove any remaining nits that you can find. The California Department of Public Health recommends that nit combing should be done with a nit comb every day for 2 weeks.

Routine screening at schools
The California Department of Public Health states “There is a lack of evidence showing that routine class or school-wide screening reduces lice infestation rates. Moreover, many schools now lack the resources to do routine lice checks. Parents should check their children for lice regularly.”

LUESD may perform classroom lice screening upon parent or staff request, if time permits. School wide lice screenings will not be performed.

What is a no nit policy?
A no nit policy requires students that have been identified as having head lice to be nit free before returning to school. The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the National Association of School Nurses are all opponents of no nit policies. The Centers for Disease Control and Prevention states that no nit policies should be discontinued for the following reasons: Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as casings. Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people. The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice. Misdiagnosis of nits is very common during nit checks conducted by nonmedical personnel. In Guidance on Head Lice Prevention and Control for School Districts and Child Care Facilities, the California Department ofPublic Health states that there is no evidence that a no nit policy prevents or shortens lengths of outbreaks. The California Department of Public Health recommends a no lice policy.

LUESD’s No Lice Policy
The Governing Board recognizes that head lice infestations among students require treatment but do not pose a risk of transmitting disease. The Superintendent or designee shall encourage early detection andtreatment in a manner that minimizes disruption to the educational program and reduces student absences.

The Superintendent or designee may distribute information to parents/guardians of preschool and elementary students regarding routine screening, symptoms, accurate diagnosis, and proper treatment of head lice infestations. The Superintendent or designee also may provide related information to school staff.

School employees shall report all suspected cases of head lice to the school nurse or designee as soon aspossible.

If a student is found with active, adult head lice, he/she shall be allowed to stay in school until the end of the school day. The parent/guardian of any such student shall be given information about the treatment of head lice and encouraged to begin treatment of the student immediately and to check all members of the family. The parent/guardian also shall be informed that the student shall be checked upon return to school the next day and allowed to remain in school if no active head lice are detected.

Upon the student's return to school, the school nurse or designee shall check the student for active head lice. If it is determined that the student remains infected with head lice, the school nurse or designee shall contact the student's parent/guardian to discuss treatment. As needed, he/she may provide additional resources and/or referral to the local health department, health care providers, or other agencies.

When it is determined that one or more students in a class or school are infested with head lice, the principal or designee may, at his/her discretion, notify parents/guardians of students in that class or school and provide them with information about the detection and treatment of head lice.

Staff shall maintain the privacy of students identified as having head lice.

Student Absences
LUESD’s No Lice Policy allows students identified with head lice to remain in school until the end of the school day. This is because once the student has been identified as having head lice, he/she may have had head lice for one month or more. Remaining in school until the end of the school day poses little additional risk of transmission to others (Frankowski & Boochini, 2010). Treatment for head lice should be provided at home immediately.The student is allowed to attend school the following day if there are no active head lice present.

The Centers for Disease Control and Prevention report that “Head lice are not known to transmit any disease and therefore are not considered a health hazard.”

Due to these two reasons, there should be no student absences related to head lice. All absences reported to the school due to head lice will be marked as unexcused absences, unless a health care provider writes a note excusing the child from school. Only then will the absence be marked as an excused medical absence.

Parent Resources

American Academy of Pediatrics Links:

California Department of Public Health Links:

Care Facilities. 

Centers for Disease Control and Prevention Links:

National Association of School Nurses Links: