Head Lice --from a scientific viewpoint

• One of the worst "problems" of head lice is adult attitudes.
• Head lice is not a serious medical condition.
• Over treatment with lice treatment shampoos is more serious than the head lice.
• "Irrational" reactions to head lice can lead to fumigating classrooms, schools, buses, etc ..... this is expensive and unnecessary.
• Much "information" about head lice is based on old, unproven information generated more than 80 years ago, some of it propagated by the companies who profit from the sale of lice shampoos and sprays.
• Direct physical head to head contact is the usual method of transmission.
• Transmission via clothing, hats, furniture, carpets, school bus seats and other objects is not likely because of the biology of head lice.
• Lice are fragile, and the chances of being passed on hats and combs is unlikely.
• Carpets, furniture and pets are not sources of infestation.
• There is no significant relationship between hair length and transmission.
• It is unlikely that a nit on a stray hair shaft will hatch because the only optimal conditions exist on the human head.
• Stray lice that fall off a head are either injured or dying and incapable of causing a new infestation.
• In time, inbreeding of lice on a person's head causes them to die spontaneously, that's why kids do not become covered with them. It is a self-limiting condition.
• It is possible to tell whether treatment has been successful by the appearance of the eggs.
• Considering the average case of head lice is 3-4 months old before it is detectable, a strict no-nit policy is not necessary or effective and only deprives children of educational
• Although schools, day care centers, etc. are often blamed for head lice outbreaks, it is the family unit that maintains cases leading to outbreaks in schools.

Based on nursing knowledge and factual information from an entomologist, the following steps are safe and effective approaches:

• Refer student to me to confirm treatment. I can check for evidence of killed or live nits.
• Do not exclude a child with evidence of dead nits, just because you can see them. I either remove them or support the parent in removing them.
• I try to educate parents to avoid misconceptions and overreactions, including punitive measures (such as shaving student's head). This also allays parents' anger toward the school.
• Never tell a parent to treat "just in case". The shampoos can be toxic and may cause real health problems.
• If a child does have live lice on his/her head, the possibility of transmission to others has already been present for at least a month before any symptoms or detection was possible. To immediately exclude that child, especially if the child will just be sitting somewhere else in the school, cannot be justified from either a medical, nursing or social perspective, and sends a negative message to the child.
• Parents may have many misconceptions, which places pressure on school staff. As with any health condition, educating and supporting the child and parent with factual, non-judgmental information is better than having policies and practices driven by misinformation.
• Minimize head to head contact as much as possible in your classrooms if you are concerned about transmission (without embarrassing the student). Exclusion from class or school is not necessary.

Please feel free to refer any anxious student or angry parent to me. As the school nurse, this gives me an opportunity to educate them. I will continue to work with families, who are the real source of recurrences. Head lice will never be eradicated, but I feel that with these approaches, l am able to manage cases in the school.