HEAD LICE GUIDELINES
Guidelines for Nurse Management of Head Lice in School

1. If teacher or other school employee views the following, the student is to be referred to the school nurse or school health aide for a pediculosis screening:
   1. Excessive scratching of the scalp
   2. Observation of nits or lice in hair
2. If nits are observed greater than 1 cm from the scalp, school nurse will notify parent/guardian at end of school day, if possible, and will provide information on parent monitoring and methods of combing and elimination without the use of chemical treatments at this time.
3. If live lice on the scalp are observed, school nurse will notify the child’s teacher immediately and parent/guardian at end of the school day, if possible, and will recommend prompt treatment with over-the-counter product or consult with child’s pediatrician. Parents will be instructed to check others living in close quarters and will be encouraged to talk to other parents of child’s close playmates and to treat only if they have live lice as well.Teacher will be instructed to not allow child to use any shared headphones, helmets, hats, combs/brushes or clothing.
4. At the school nurse’s discretion, siblings and other persons who are felt to be in close contact with a person with live lice, will be inspected for infestation and referred if needed
5. If the child with lice is very young, the school nurse may choose to check classmates in preschool and kindergarten
6. At the school nurse’s discretion, a child may be excluded if there is an apparent lack of adequate follow-through by parents or guardian in treating live lice or viable nits
7. Children with live lice or nits may ride the bus to and from school
8. When returning to school after home treatment with pediculocide,student will be checked by school nurse or health aide before reporting to classroom.
9. Students found to have non-viable nits on recheck do not need to be referred for further treatment and will be monitored at the nurse’s discretion. Student may remain in school; parent will be re-instructed on importance of removing all nits
10. Parents who have been instructed to treat their child with a pediculocide will be instructed to repeat treatment in 7 to 10 days
11. If a parent does not follow through with the proper treatment, the child with lice will be excluded from school until proper treatment has been completed.
12. In accordance with recommendations of the American Academy of Pediatrics, when a case of head lice has been discovered, it is not necessary to send letters home to other parents

Rationale

1. Lice do not spread disease
2. Over-the-counter treatments sometimes need to be repeated 2-3 times before the lice are eradicated
3. Lice are mutating to resist certain over-the-counter treatments
4. The presence of nits or eggs alone is not indicative of an active infestation, especially if located greater than 1 cm from the scalp; nits greater than 1 cm from the scalp are likely not viable
5. Nits are strongly attached to the hair shaft and therefore are not likely to be transferred to others
6. Lice crawl quickly; they do not hop, jump or fly
7. Primary mode of transmission is head to head contact
8. Child with lice infestation has likely had the condition for 1 month or more
9. Removing child from the classroom causes lost lesson time, increased absences, classroom disruption, confidentiality breach, and unnecessary stigma and stress to child, family and school community
10. Mass screenings are unnecessary as nits alone are not indicative that a child will develop an active infestation; in-school transmission of lice is rare
11. Policies based on presence of nits will be inconsistent and may unnecessarily exclude children from school
12. Children are not excluded for the common cold, yet that is easily transmitted in schools

References

1. American Academy of Pediatrics (AAP)
2. National Association of School Nurses (NASN)
3. Centers for Disease Control and Prevention (CDC)