Should children with head lice and/or eggs (nits) be allowed to go to school? This touchy topic is a debate facing school districts across the country. Parents whose kids have missed school due to head lice are frustrated. Parents who have spent money and time treating lice only to have their child re-infested from a classmate are frustrated.
What Is Nit Policy?
Until recent years, almost every public school had a no nit policy. A no nit policy means that children are not allowed in school with any nits in their hair. If a child was discovered to have lice or nits, he or she was sent home from school.
For many years, a no nit policy in schools was the recommended standard. It was thought that to keep other children safe and to prevent the spread of head lice, children found to have lice needed to be completely clear of all signs of lice before being allowed to return to class.
When LiceDoctors was first founded, almost every school district in the United States had a no nit policy. Now the majority of families we treat attend schools in districts that have dropped their no nit policies, mainly due to revised recommendations from the Center for Disease Control (CDC), the American Academy of Pediatrics (AAP), and the National Association of School Nurses (NASN).
In April 2015, AAP issued the official advice that a healthy child should not be restricted from attending school because of head lice or nits but should finish the school day, be treated, and return to school. All three of these important medical groups now recommend that children with only nits be allowed to remain in school.
This new advice has caused nit policy in schools across the US to vary wildly, leaving parents confused and concerned.
No Nit Policies Guidelines
In practice, there is vast variability in how schools interpret and enforce these policies. Some school nurses will take it upon themselves to pick out the nits if it appears to be a very mild case, thereby allowing the child to stay in school.
Many school nurses don’t have the time, training, or resources to assist in the treatment and send a child home immediately upon seeing a single nit. Sometimes, only children with nits within ¼ inch of the scalp will be sent home (nit shells remain in the hair after hatching unless removed, and any “nits” found over ¼” from the scalp are likely just old hatched shells).
The main alternative head lice school policy, a “no live lice” policy, allows children with nits to stay in class, while students found to have live bugs will be sent home.
In some schools, the child with live bugs will be allowed to remain in school until the end of the school day and then will be sent home to be treated. In other cases, children with live bugs will be sent home immediately. Either way, children are not allowed back to school until all live lice have been killed.
Suppose a school completely forgoes any head lice and school policies. In that case, that means children with live lice and nits are permitted to remain in school, even if no effective treatment is being pursued (although schools with very liberal policies usually go above and beyond to educate parents on the prevention and detection of head lice).
Pros of No Nit Policy
- Live bugs are light-averse and quickly burrow back into the hair when the hair is parted to look for nits, so it is widespread to miss live lice and assume that only nits are present.
- If there are nits, there had to have been live lice to lay them at some point, so any child who hasn’t yet been treated for lice and nits may also have live lice that are hiding well.
- The cause of lice recurring is that any treatments that do not remove all of the nits from an infested person’s head fail in the long term. Just a couple of nits left in the hair can start a case all over again. While nits themselves are not contagious, they become contagious a few days after they hatch when the baby bug (nymph) matures and begins to crawl. Who knows when each nit will hatch and become an active case again?
- By refusing to allow children in a class with any sign of head lice, families are incentivized to provide effective treatment for their family the first time and remove the nits rather than trying ineffective OTC chemical shampoos. This saves time in the long run by avoiding re-treatment and ensures that families are not repeatedly exposed to harmful chemicals.
- Most parents who have never had lice are in favor of no nit policies, which they believe may help to contain the spread of head lice and protect their lice-free status. When there are nits in the class, and school policy stipulates that these kids need to leave, many parents feel relieved.
- Children are more likely to socialize if they are confident that their classmates are lice-free.
- Schools with no-nit policies can reassure parents that their children will be safer from lice at their institution.
- Sending kids home for just nits allows schools to skip the difficult task of searching for live lice, which are notorious for hiding, and removes the burden of determining if a nit in the hair is viable. Parents then assume responsibility, allowing staff to direct their attention to other matters.
Cons of No Nit Policy
- The AAP and NASN maintain that a head lice school policy that allows for no nits has shown over time to be ineffective in preventing the spread of lice within communities.
- Nits are not contagious, as they are glued to the hair. Even if they were to hatch during class, it would take days for the nymphs (baby bugs) to grow up and become contagious.
- By the time a case of lice is easily visible, it has likely been active and contagious for at least three weeks, so immediate removal of the student from the class upon finding nits is like closing the barn door after the horse has bolted.
- After the lice are successfully treated, non-viable empty nit shells can still appear to be nits.
- Lice are a nuisance; they are not generally dangerous, nor do they transmit other diseases.
- No-nit policies are unjust to those with lower socioeconomic means and may be unequally applied to students due to observer bias.
- Removing a child for lice makes their situation obvious to their peers and may leave them vulnerable to bullying.
- When parents must skip work to stay home with children who would otherwise be at school or leave work early to pick up children found to have nits, this missed income poses an undue hardship on some families.
- Families with multiple children with lice may not have time to remove all nits in one evening, whereas killing all of the live bugs can be done one night, so the children aren’t contagious.
- Too many children miss too much school due to recurrent lice, which is second only to the common cold as a cause of absenteeism. Lost education time for children has a negative overall economic and social impact on communities.
- A no-nit head lice policy may put an additional burden on already tight school resources to police whether students still have lice. The cost to schools of spending time looking for head lice, when paired with other factors, has been deemed not worth any benefit that may come from a child’s exclusion from school for the presence of nits.
- Misdiagnosis is common during head-checks conducted by inexperienced or non-medical personnel, leading to issues when parents disagree with the school’s assessment and have to miss work and pay for a doctor’s visit to prove it was a false-positive.
- Children can miss weeks of school or even have to repeat a grade because of all the treatment methods that claim to be effective but are not.
How to Make the No Nit Policy Succeed
LiceDoctors believes that schools should maintain some lice policies while applying common sense and encouraging effective treatment and responsible head lice management. It is unreasonable for schools to allow students with bugs to go to class; parents don’t want their children in a classroom where students are crawling with contagious lice. Yet nits are not contagious, and if proper treatment is done to ensure no live lice are present, missing school for nits is also unreasonable.
When a child is treated for head lice by a reputable professional and adheres to an effective aftercare plan, the child is at very low risk of being contagious again, even if a few nits are discovered later.
Educate Parents and Teacher on Lice
Schools should never send kids home with no information other than that they have lice and are not to return until there are no nits in the hair. Leaving parents trying to figure it out on their own before school starts tomorrow leads to frustration for everybody as the lice keep recurring.
Instead, schools should provide parents with head lice education before it’s an issue so that they can be prepared. For many parents, suddenly learning their child has head lice is upsetting and overwhelming.
There is a lot of information online, not all of which is accurate or helpful. Some parents still associate lice with a stigma, so they don't want to reach out for help. Most parents panic and buy chemical lice shampoos that are mostly ineffective. We get calls for service every day from parents who have spent significant time and money and missed work and school trying ineffective methods to eradicate head lice.
At LiceDoctors, we have created a library of accurate educational content on head lice, provided free to all at licedoctors.com.
Screening and Early Detection
Since many schools no longer even do head checks for nits and school policy continues to become more relaxed, parents should take the initiative to do their head checks regularly.
If you suspect that your child has head lice, give LiceDoctors a call; we can either come to your home discreetly to check for you, or we can give you tips on what to look for and discuss what you’re finding.
We support smarter school lice policies that are education-focused because there are so many ineffective treatments and myths out there. “Treated” does not necessarily mean “not contagious,” yet having nits does not necessarily imply “contagious.” While strict no nit policies may not be a practical standard for all communities, there are obvious pros for maintaining some rules regarding nits and school policy.
But how can common-sense policies be practically applied by busy school administrators?
If just a few nits remain in the hair, but the lice have been killed, it is safe for the child to return to school, assuming that parents are doing an effective follow-up plan at home (caveat: chemical treatments are generally ineffective in eradicating nits and killing chemical-resistant super lice).
A child who is heavily infested with nits is just too at risk of having undetected hiding lice or transmitting lice when those nits hatch. The parents are likely trying but don’t understand what treatment is effective and how to do it.
Provide parents with educational resources, like our online Education Center, and understand that nit removal is sometimes an ongoing process. Focus on making sure the kids aren’t contagious, and the parents know how to eliminate the nits. That nit elimination is essential to get rid of a case for good.
We can eradicate a case of head lice from a whole family in just one visit, so you can return to business as usual without missing work or school, without the stress of uncertainty, even without doing any laundry or cleaning. No matter what your child’s school requires, outsource your lice issue to LiceDoctors to make it a moot point.