Head Lice

Exclude from group setting?
The American Academy of Pediatrics no longer recommends routine exclusion of children from K-12 settings for head lice. Child care licensing regulations also no longer require the routine exclusion for head lice. However, child cares may choose whether to include head lice and/or nits in their facility’s exclusion guidelines and whether exclusion is to be immediate or at the end of the day. The exclusion policy must be written and available to parents. Head lice are not a health hazard and are not easily spread in school-age classrooms. However, parents and guardians must be informed that prompt, proper treatment is in the best interest of their child and his or her classmates. Treatment should be required before returning to care.

"Students diagnosed with live head lice do not need to be sent home early from school; they can go home at the end of the day, be treated, and return to class after appropriate treatment has begun. Nits may persist after treatment, but successful treatment should kill crawling lice.

Head lice can be a nuisance but they have not been shown to spread disease. Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.

Both the American Academy of Pediatrics (AAP) and the National Association of School Nurses (NASN) advocate that “no-nit” policies should be discontinued. “No-nit” policies that require a child to be free of nits before they can return to schools should be discontinued for the following reasons:

- Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
- Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
- The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
- Misdiagnosis of nits is very common during nit checks conducted by nonmedical personnel."
(Source: Centers for Disease Control and Prevention)

What are head lice?
Head lice are tiny insects about the size of a sesame seed. They live and lay their eggs (called “nits”) on hair close to the scalp. Lice do not carry disease and they do not live on pets or other animals. A single insect is called a “louse”. There are three stages in the lifespan of a louse including the nit (egg), nymph (young adult), and adult stage. An adult louse can live on the human head for about 30 days.

What are the symptoms of lice?

Symptoms of lice include itching, sores from scratching the head, a sense of something moving in the hair, and irritability. Lice are active at night, so sleep may be affected as well. Scratching can lead to skin sores on the scalp and skin infections. In some cases, there are no symptoms.

How are lice spread?

Lice can crawl from one person to another. They do not fly or jump from one person to another. Most often, lice are spread by direct head-to-head contact with a person who has lice. There is also a small possibility that lice may spread when a person with lice shares items like coats, hats, helmets, pillow, brushes, and other personal items, or when these personal items come in direct contact during storage.

Who is at risk for lice?
Anyone in contact with an infested individual, or contaminated items, can get lice. It is not associated with economic status or personal hygiene. It is more common in preschool children and their families because of close contact.

What is the treatment for lice?

There are a variety of treatments for lice. Pesticides are available for purchase over-the-counter and by prescription. Carefully follow the package directions as some products may need to be applied again to remove newly hatching lice. Using a nit comb every couple days to remove nits and lice may help prevent re-infestation. Consult with your health care provider for treatment recommendations especially if you are pregnant or breastfeeding, or if the child is under 2 years of age.

How are lice diagnosed?
By carefully inspecting hair with a bright light and a magnifying glass, lice and nits can be identified. They are usually close to the scalp around the ears and along the nape of the neck. They feel like little grains of sand on the hair.

Household cleaning for lice
Only items that have been in contact with the head of the person with infestation in the 48 hours before treatment need to be considered for cleaning. Chemical treatment of the environment is not advised.

• Wash sheets, pillowcases, towels, and clothing in hot (130°F) water and dry on a high heat cycle.
• Items that cannot be washed can be:
   • sealed in a plastic bag for at least two weeks, or
   • dry-cleaned.
• Soak brushes, combs, and hair ornaments in hot water (at least 130°F) for 5–10 minutes.
• Vacuum the floor, furniture, and car seat. Throw the vacuum bag away or empty the vacuum canister in an outside garbage container after vacuuming.

Note that lice do not live outside of a human body for very long, so intensive cleaning of the environment is less helpful than measures that directly target the individual with lice.

How is the spread of lice reduced?
• Regularly inspect the hair of children in group settings.
• Avoid head-to-head contact with individuals who have lice.
• Do not share hats, combs, coats, pillows, or other personal items.
• Keep long hair pulled back.
• When doing head checks, wash hands after checking each child.
• In group settings:
   • Provide separate storage areas for each person’s clothing and other   personal items using individual cubbies, lockers, or bins with solid walls.
   • Assign sleeping mats and bedding to only one child and store these separately when children are in group care. Children on mats or cots should sleep at least 18” apart and in a head-to-foot or foot-to-foot arrangement.

This information was printed from the Snohomish Health District’s website by your school. It is for information only and is not meant as a substitute for consultation with your health care provider.