In an effort to prevent the spread of head lice infestations to students families and communities, schools and other child care settings have implemented control measures and head lice screening programs. After a direct visual examination by the nurse at school or other nonmedical personnel with expertise in head lice, the decision on whether or not the discovery of head lice or nits should qualify as a school exclusion of an infested child falls to the school nurses’ perceptions on lice. However, head lice continue to build permethrin resistance and only a small number of families will completely eliminate lice with traditional treatment options; consideration should be made as to whether the risk associated with head lice outweighs the risks associated with the burden of unnecessary absenteeism, including the annual economic loss owing to these absences. This touchy topic is a debate facing school districts across the country. Should children with head lice and/or eggs (nits) be allowed to go to school, even in the absence of crawling lice? Is head lice even a public health issue? Does head lice affect community health?
WHAT IS NO NIT POLICY IN SCHOOLS?
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 eggs (nits) on their hair head. If a child was discovered to have lice or nits on the hair shafts, he or she was sent home from school. But, do no nit policies help with pediculosis prevention?
NO NIT POLICY DEVELOPMENT
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 a head lice infestation, children found to have head lice needed to be completely clear of all signs of head louse pediculus capitis (human lice), including head lice eggs, whether viable eggs or empty shells more than an inch from the scalp, 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 government agencies such as the Center for Disease Control (CDC), the American Academy of Pediatrics (AAP), National Pediculosis Association, and the National Association of School Nurses (NASN).
In April 2015, the AAP issued the official advice that a healthy child should not be restricted from attending school because of head lice - adult 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 as head lice are a nuisance but not considered a public health issue. These organizations maintain that the risks associated with head lice are less than those of a child missing days of school.
This new advice has caused no nit policies in schools across the US to vary wildly, leaving parents confused and concerned. Discussions of whether head lice is a public health matter continue.
SCHOOL NO NIT POLICY IN PRACTICE
In practice, there is vast variability in how schools interpret and enforce these no nit policies. Some school nurses will take it upon themselves to comb with a louse comb or pick out the head lice eggs, and empty shells found more than an inch from the scalp if it appears to be a very mild case, thereby allowing the child to stay in school and avoiding the burden of unnecessary absenteeism.
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. On occasion, children are diagnosed with head lice during a routine screening at school, whether with a school nurse or other nonmedical personnel, with pediculus humanus capitis (human head lice) and are sent home from school, only to be treated unnecessarily. Sometimes, only children with nits within ¼ inch of the scalp will be sent home (nits remain in the hair after hatching unless removed, and any “nits” found over 1/4 inch from the scalp to one inch from the scalp are likely just old empty shells). More often than not now, school nurses no longer do school screenings.
Today the most common head lice school policy is a “no live lice” policy. In this case, unlike no nit policies, children with nits are permitted to stay in class, while students found to have crawling lice or live bugs, will be sent home. School head lice screening of all students by school nurses has been discontinued in the majority of schools. Removing nits from human hair is no longer required for a child to stay in class as the nits are not contagious until after they hatch.
In some schools, a child with live bugs in the hair shafts will be allowed to remain in class 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 in the class until all crawling lice on the hair shafts have been killed.
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
- Health authorities AAP and the National Association of School Nurses maintain that no nit policies have shown over time to be ineffective in preventing the spread of lice within communities.
- Risks associated with head lice are minimal. Nits are not contagious, as they are glued to the hair, about 1/4 inch from the scalp. 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 head 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 head lice are successfully treated, non-viable empty nit shells, or extinct infestations, can still appear to be nits and can be misdiagnosed by nonmedical personnel as an active case of head lice.
- Head 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 from head lice makes their situation obvious to their peers and may leave them vulnerable to bullying and serious psychological problems, in part due to the false stigma that poor personal hygiene is a risk factor for lice.
- 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, especially when there are no cost effective solutions available to them.
- Families with multiple children with head lice may not have time to remove all nits in one evening, whereas killing all of the living lice can be done in one night, so, while they are not nit free, the children aren't contagious, even children with long hair.
- Too many children miss too much school due to recurrent lice. The burden of unnecessary absenteeism for head lice annually is second only to the common cold as a cause of absenteeism. Lost education time due to no nit policies for children has a negative overall economic and social impact on communities.
- No nit policies may put an additional burden on already tight school resources to police whether students still have lice. The cost to schools of putting in place lice control strategies, such as spending time looking for head lice, when paired with other factors, has been deemed not worth any benefit that may come from the burden of unnecessary absenteeism for the presence of nits.
- Misdiagnosis is common during head checks conducted by inexperienced or nonmedical 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 ineffective head lice treatments that claim to be effective but are not due to lice resistance to over-the-counter treatments for head lice.
HOW TO MAKE THE NO NIT POLICY MORE EFFECTIVE
1. 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 they are lice free, meaning there are no nits or crawling lice in the hair. Leaving parents to try to figure it out on their own before school starts tomorrow leads to frustration for everybody as the head lice keep recurring.
Instead, schools should provide parents with head lice education, including risks associated with head lice, 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 head lice infestation with a stigma, especially that of poor personal hygiene, 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 lice treatments 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.
2. Screening and Early Detection
Since many schools no longer even do head lice checks for nits and school policy continues to become more relaxed, students, families, and communities should take the initiative to do their head checks and implement regular control measures to do their part for head lice control.
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.
WHY NO-NIT POLICIES MAKE NO SENSE
There are some risks associated with head lice, so 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 and outweighs the risks associated with the missed time at school.
When a child is treated for head lice by a reputable professional and adheres to an effective aftercare plan, the child, in addition to students, families, and communities, is at very low risk of being contagious again, even if a few nits (lice eggs) are discovered later.
FINAL THOUGHTS ABOUT NO NIT POLICY IN SCHOOLS
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 to 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, even if they are not lice free (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 that the kids aren't contagious and that the parents know how to eliminate the nits. Removing nits is essential to get rid of a case for good.
LiceDoctors 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, and even without doing any laundry or cleaning. No matter what your child's school requires, outsource your lice issue to LiceDoctors and make an appointment for lice treatment to make it a moot point.