School districts adjust ‘no-nit’ policies, focus on effective treatments at home

Head lice will find few defenders. The parasites – found on human heads, eyebrows and eyelashes – survive by biting their hosts and feeding on their blood, and just the thought of them can make the skin crawl.

But they’re not a health hazard, according to pediatricians and school nurses groups – and they’re not worth missing school over.

The American Academy of Pediatrics changed its recommendations for the treatment of children with head lice in 2010, calling for an end to “no-nit” policies that required students to stay home until every last louse egg had been removed from their hair. The National Association of School Nurses revised its position in 2011, saying children with live lice should remain in class and their parents contacted to discuss treatment at the end of the day.

Spokane-area school districts have adjusted their policies, too, moving away from no-nit policies while still requiring that students are treated for lice before they come back to school and striving to educate parents about eradicating the bugs.

“It happens to everybody,” said Christi Malsam, school nurse supervisor for the West Valley School District. “There’s no prevention, no matter how rich you are or how clean you are.”

Q. What are lice, and how are they spread?

A. Lice are six-legged wingless insects that grow to be roughly 2 to 3 millimeters long.

They lay oval-shaped eggs, or nits, at the base of the hair shaft close to the scalp. The eggs are about the size of a knot in a piece of thread, according to the Centers for Disease Prevention and Control, and very difficult to see.

Head lice are most common among preschoolers and elementary school students and the people who live with them. The CDC estimates 6 million to 12 million infestations occur each year among 3- to 11-year-olds.

Lice don’t jump, but they’re fast crawlers. They’re spread by direct contact with the hair of an infested person. It’s uncommon for lice to be spread through contact with clothing or other personal items used by an infested person, the CDC says.

Most direct contact leading to the spread of lice happens outside school, Malsam said, such as at children’s sleepovers.

Q. How do schools handle lice now?

A. Spokane, Mead and Central Valley, East Valley and West Valley schools districts are among those that allow kids to return to school with nits in their hair after they’ve received treatment to kill lice.

Patti Buck, a nurse with the Mead School District, said her district’s policy draws on data showing that “it’s not worth keeping a child out of school, that it’s not a necessity. Lice doesn’t cause illness – it’s not contagious or anything like that.”

The West Valley School District also reviewed its policy in response to recommendations from the doctors and nurses groups and other science-based organizations, Malsam said.

“If it’s 3 o’clock in the afternoon especially, if they’ve been in that classroom all day, whoever’s been exposed has already been exposed, potentially,” Malsam said.

And because it’s often difficult to eliminate nits in one treatment – the tiny eggs are stuck tight to individual hair shafts – a no-nit policy could force a child to miss school for up to two weeks at a time.

Parents are usually eager to comply with the treatment requirement, Malsam said, and schools in her district can help low-income families pay for it. The district’s nurses talk with parents about how to use over-the-counter products and special combs to kill and remove as many bugs and eggs as they can.

“What we’re looking for is to make sure (parents) understand how to treat their child, they have access to the products, and they really work at that combing,” Malsam said.

Q. What happens at school after a parent or school employee discovers a student has lice?

A. It’s usually up to parents to call the school to report a case of lice. Otherwise, a teacher who notices an itchy student might send them to a school nurse for a check.

As in many schools, Spokane Public Schools send letters home with all students in the infested student’s class – without identifying the student – along with an informational brochure from the Spokane Regional Health District about what to do if they find lice.

It’s up to parents to treat the lice and inform the school, said Wendy Bleecker, the district’s director of student services. The Spokane district created its lice guidelines around 2006, she said.

The letters are meant to alert other parents to be on the lookout, said Malsam, of West Valley.

“We try to keep things as calm as possible, so people don’t get too upset and angry about it,” she said.

After students are treated at home, nurses recheck their hair before they return to their classrooms, said Buck, of Mead. The students are often accompanied by a parent, and nurses point out any remaining nits to them.

“We just emphasize the fact that they need to keep combing out for the next couple weeks,” Buck said.

Q. How else are parents advised to eliminate lice?

A. Many schools follow advice from the Spokane Regional Health District, passing along its guidelines on the types of products to use to kill lice and nits.

The health district advises using over-the-counter products available at drugstores, grocery stores or medical clinics. While the products won’t kill all the bugs and eggs, they’re the best way to get started, the health district says.

It recommends washing bedding and towels normally, vacuuming, and soaking combs and brushes before repeating treatment seven to 10 days later. It also advises continuing to check for lice and notifying anyone who might have been exposed.

Buck, of Mead schools, said she discourages parents from using unproven home remedies such as applying mayonnaise and vinegar to hair. And experts say if a treatment hasn’t worked, it’s better to try another one rather than trying the treatment again, she said.