I don’t know about you, but when I even think about head lice I start to feel itchy. Insect infestations of any kind are something most parents and guardians actively strive to avoid, knowing that an infestation can mean many hours of cleaning the house and laundering bed linens, laboriously combing and picking nits (lice eggs) from individual strands of hair, and of course the very personal discomfort that comes with itchy bites. Almost all people regard bugs and specifically biting bugs like head lice as the enemy.
There is something particularly repulsive about parasitic insects. Head lice, which feed on human blood, provoke strong feelings in people and having head lice is stigmatizing. It is a commonly held perception that this parasite infestation is related to poor personal hygiene and a lack of cleanliness. It is feared that these parasites can transmit diseases. Some people believe that children get head lice because of negligent parenting. Additionally, it is the perception that individuals who have head lice should be isolated and avoided so that these little villains cannot fly or hop onto other people and spread the infestation. None of these stigmatizing perceptions, however, are supported by the research.
Each individual brings personal perceptions and values to any debate or discussion influencing her or her opinions. However, it is an important role of school leaders to put these perceptions aside and focus on making fact-based and data-driven decisions in their mission to guide and oversee an educational program and environment that protects the health, welfare and the privacy of the students.
Some Facts 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 feed on human blood several times a day and live close to the human scalp. According to the Centers for Disease Control, head lice are not known to spread disease.
An estimated six to 12 million infestations occur each year in the United States, most commonly among children ages 3 to 11 years old. Children attending preschool or elementary school, and those who live with them, are the most commonly affected. The life cycle of a head louse has three stages:
- Egg/Nit Nits are lice eggs laid at the base of the hair shaft nearest the scalp. Nits are firmly attached to the hair shaft, oval-shaped, very small and hard to see. Head lice nits usually take about 8-9 days to hatch. Only the nits located no more than ¼ inch from the base hatch, so nits farther up the hair shaft may have already hatched or may be empty nits or casings.
- Nymph A nymph is an immature louse that hatches from the nit. To live, a nymph must feed on blood. Nymphs mature into adults about 9–12 days after hatching from the nit.
- Adult The fully grown and developed adult louse. To survive, adult head lice must feed on blood. An adult head louse can live about 30 days on a person’s head but will die within one or two days if it falls off a person.
Many of the perceptions that make head lice such a contentious and stigmatizing condition have been disproven by research. Getting head lice is not related to cleanliness of the person or his or her environment. Fastidious personal grooming and hygiene does not deter lice or protect a person from getting head lice. Head lice do not have wings and do not fly, hop or jump from person to person. They so securely attach to the hair shaft that they are almost always transferred by direct contact with hair that has lice on it. It is uncommon for lice to be spread by sharing items such as clothes, hats, hairbrushes, and combs. Head lice are specific to humans so pets cannot get or transmit head lice. Most important, head lice do not transmit disease or pose a health risk; however, someone with head lice can develop an infection of the skin from scratching.
In reviewing school policies and regulations over the years, various practices are described for the intervention and prevention of head lice infestation. Some districts conduct regular classroom or even schoolwide screenings of students for the presence of live lice and/or nits. Some policies require the immediate removal of students who are found with live lice or nits and require that all evidence of lice or eggs be eradicated before a student may return to school (this is called a no-nit policy). There are varying approaches for notifying the community when a case of lice is identified that range from classroom to schoolwide notification of the parents and guardians. Many of these policy approaches reviewed in light of the research and data are outdated, ineffective in preventing the spread of infestation and costly in terms of staff resources and student absenteeism.
The National Association of School Nurses (NASN) takes the position that “…the management of head lice (Pediculus humanus capitis) in the school setting should not disrupt the educational process…Evidence-based strategies include abandoning “no-nit” school policies, allowing children to remain in class and participate in school-sponsored activities when live lice or nits are found on their heads, notifying parents/caregivers at the end of the school day when findings indicate the presence of a head lice infestation, and educating parents/caregivers about evidence-based treatment options.”
NASN, citing the research and recommendations of the CDC, advocates for other evidence-based strategies for the effective management of head lice including:
- Eliminating mass school screening for head lice;
- Providing privacy when conducting student health assessment for suspected or reported cases of head lice; and
- Educating families about how to assess their children for suspected head lice.
Similarly the New Jersey Department of Health does not recommend exclusion after treatment. They recommend that students and their parent/guardians be referred for treatment at the end of the program day and readmitted on completion of treatment.
An updated report published by the American Academy of Pediatrics (AAP), Head Lice, shares the position of NASN and asserts that: “No healthy child should be excluded from school or allowed to miss school time because of head lice or nits. Pediatricians may educate school communities that no-nit policies for return to school should be abandoned.” Additionally, the report summarizes studies on schoolwide and classroom screening for nits and concludes that “…screening for nits alone is not an accurate way of predicting which children are or will become infested, and screening for live lice has not been proven to have a significant effect on the incidence of head lice in a school community over time…Because of the lack of evidence of efficacy, routine classroom or schoolwide screening should be discouraged.”
In the report, the AAP also suggests that when managing an identified case of head lice “common sense and calm should prevail within a school when deciding how ‘contagious’ an individual child may be (a child with hundreds versus a child with two live lice).” The actions taken should be determined by the school doctor or nurse and reflect the severity of the infestation, for example, checking other children who are known to have close physical contact with the affected student. The report suggests that many experts believe that alert letters create public alarm and violate a student’s privacy rights. Some experts believe that the parents or guardians of the students in the class should only be alerted when a high percentage of students are affected. There is no evidence that alert letters are in any way effective in the prevention or intervention of head lice.
Since head lice pose no health risk, perhaps the most damaging aspect of head lice is the stigma associated with having an infestation. A study published in the International Journal of Dermatology reported that 79 percent of the questionnaire respondents expressed strong negative feelings about head lice including disgust, horror, embarrassment, anxiety and guilt.
In Tenafly the board determined that a student violated the district harassment, intimidation and bullying policy when a student identified a classmate as having head lice, embarrassing the classmate. The commissioner upheld the board’s decision concluding that head lice was a distinguishing characteristic according to the legal definition of harassment, intimidation and bullying (N.J.S.A. 18A:35-15, W.C.L. o/b/o A.C. v. Board of Education of the Township of Tenafly). Because of the strongly negative social perception of head lice, the need for sensitivity and the protection of privacy are paramount considerations when developing district policy and procedures.
It is the position of the National Association for School Nurses that professional school nurses “advocate for school policy that is more caring and less exclusionary (i.e., elimination of the “no-nit” school policies). This position is supported by the New Jersey State School Nurses Association. Boards are being petitioned to review and revise outdated policies and practices on head lice.
When the public perception conflicts with the facts there is the potential for controversy, so board members should be prepared. The best armor that a board has for protection is a strong rationale for its decisions, fortified by diligent research and a deep understanding of the facts. A public information program that provides accurate education to the community about the facts can diminish the ferocity of the controversy and facilitate community support. Publishing clear information regarding the district’s procedures when head lice is discovered may also ease minds.
As the National Association of School Nurses asserts, “the management of head lice in the school setting should not disrupt the educational process.” Supporting student achievement and taking measures to prevent the disruption of the educational program is the role of the board. Putting aside personal perceptions and trying to be objective even when the facts seem counterintuitive; carefully considering the facts and consulting the experts are best practices when developing and adopting policy. Finally, when a consensus has been reached, supporting the position of the majority regardless of personal objections can help give the community confidence in the board’s position. A strong and fact-based rationale supported by the board makes it more difficult for the members of the school community to argue about details that are not important, or, dare we say, to nitpick.
NJSBA policy services has sample policies and regulations regarding head lice that we will email upon request. Please contact Policy Services.