These school guidelines serve to outline the roles and responsibilities of the Ladue School District in community efforts to control head lice (pediculus capitis). These guidelines draw on information obtained from the Missouri Department of Health, the American Academy of Pediatrics, the National Association of School Nurses, and the Harvard School of Public Health.
Head lice are parasitic insects that live and lay their eggs on the human scalp. Head lice rarely (if ever) cause direct harm, and they are not known to transmit infectious agents from person to person. Lice infestations are not a medical problem or a disease. Lice at times, are a burden and a nuisance because their presence may cause itching and loss of sleep. The louse’s saliva and feces may sensitize people to their bites; thereby exacerbating the irritation and increasing the chance of secondary infection from excessive scratching. Lice lay eggs onto the hair shaft, and they take 8-12 days to hatch. Nits that have died or hatch remain firmly attached to the hair and nits that are found more than 1/4 of an inch from the scalp are unlikely to be viable. Nits cannot be passed on to someone else’s hair. The presence of nits does not indicate active infestation and there is no evidence found that the presence of nits correlates with any disease process.
The Ladue School District will use best practices in pediculous management.
- A child with an active head lice infestation who most likely has had the infestation for a month or more poses little risk to others and will remain in class until the end of the day but is discouraged from close direct contact with others. If there are complications or other health problems as a result of the presence of lice, the school nurse will use her professional judgment to determine whether the child will remain in school for the remainder of the day. The age and development of the child will be a determinant if the child cannot refrain from direct contact with others (as in the preschool and early elementary years).
- The school nurse will notify the parents either with a phone call or a note that the child has lice and that prompt proper treatment of the child is required before returning to school.
- To prevent embarrassment or being socially stigmatized, the child‘s infestation will be kept confidential.
- The parent or guardian will be given written information on head lice and encouraged to contact their pediatrician for treatment advice.
- The child may be allowed to return after treatment. The school nurse will check the child before reentering the classroom and again between 9-12 days after treatment, if requested to do so by the parent. Students will be allowed to return if nits are found; however, the nurse will encourage nit removal for the following reasons:
- Nit removal may decrease diagnostic confusion
- Nit removal may decrease the possibility of unnecessary re-treatment
- Some experts recommend removal of nits within 1 cm of the scalp to decrease the small risk of self-infestation
- Some lice are resistant to commonly used pediculicides
- In preschool and elementary school, the nurse will notify the parents or guardians of all children in the index child’s classroom by letter and provide educational information on head lice. Parents and guardians will be encouraged to check their children at home and treat them appropriately before returning to school the next day.
- The school nurse will provide the families with advice on current practices for the treatment of lice, how to identify lice and nits, home interventions for the family, and ways to prevent head lice. Parent education is crucial to any successful pediculosis management.
- The school nurse may direct the maintenance staff in the school on interventions in the classroom with two or more infested students; vacuuming, washing blankets, and pillows; and bagging up items in plastic that cannot be washed (stuffed animals, costumes, or hats) for up to two weeks.
- Head lice screening will not occur on a regular basis because screening programs have not been proven to have a significant effect on the incidence of head lice in the school setting. However, the school nurse will check for lice on symptomatic children who are itching or complaining of pruritus. Screening an entire classroom of children will only be done if there are more than two confirmed cases in a particular classroom.
- For the rare student who has continuing reinfestations, the school may refer the case to public health personnel for a home visit to ensure that treatment is conducted effectively.
- The school and the school district will remain calm and educate the community on the fears and myths of head lice. A student with head lice will be confidentially managed on an individual basis, with the goal being for the student’s attendance to be unaffected due to a diagnosis of head lice.
School Nurse Responsibilities:
- Notify the family of the child with a case of head lice
- Notify the families of classmates that there is a case in the class
- Screen the entire class only if there are more than two confirmed cases in the class
- Make appropriate referrals for treatment in resistant cases, educating families and staff as needed
- Initiate maintenance intervention as needed
- Treat the child as recommended by their healthcare provider prior to the child returning to school
- Notify the school nurse of an infestation if discovered in the home environment
- For two weeks, recheck the child every two to three days for nits and remove those that are within ¼ inch from the scalp
- Retreat as recommended by the primary healthcare provider