Over the counter products for controlling head lice are photographed in Washington, Monday, Nov. 4, 2013. Some parents are scratching their heads over less restrictive head lice policies that allow children with live bugs in their hair to return to the classroom for the rest of the day. Some school nurses are no longer sending home "lice notes" to parents of other children in the classroom. The policy shift is designed to help keep children from missing class, shield children with lice from embarrassment and protect their privacy. (AP Photo/J. David Ake)
When my daughter developed a bad case of head lice a decade ago, I spent hours over three days checking and removing more than a hundred tiny glossy lice eggs from my then 8-year-old’s long curly hair; it was necessary to comply with her school’s no-nit policy.
I agreed with the policy, at the time, convinced that this was the only way to deal with the problem. After all, if those nits remained and hatched new lice, my daughter could keep getting re-infested and spread lice to her friends.
Since head lice pose no health threat, public health experts argue no-nit policies are completely unnecessary. For more than a decade, the American Association for Pediatrics has urged schools to abandon their no-nit policies, citing studies that found kids with lice often unnecessarily miss a week or more of school in places with these policies.
Research also suggests that only one-third of kids with nits left in their hair go on to develop a lice problem if left untreated. Most products recommend a repeat treatment one week after the first shampoo to ensure that any bugs that hatch from the eggs – which treatments don’t destroy—will be eradicated.
In 2010, the pediatrics group updated their head lice policy and advised schools to stop doing routine lice checks and sending kids who were infested immediately home from school. “It doesn’t make sense,” said Dr. Barbara Frankowski, a pediatrician at Vermont Children’s who co-authored the group’s recommendations. “Schools don’t routinely check for strep throat, chicken pox, or flu symptoms, which are also contagious and much more dangerous.”
Some school districts, like Boston, have eliminated their no-nit policies and discreetly send kids home at the end of the day with a note if a school nurse discovers lice. “Children found to have nits are allowed to come to school,” the Boston school district policy states, “although children with adult lice should receive treatment before they return to school.”
Other schools in Greater Boston, however, remain firm in keeping their no-nit policies in place as the Newton-based National Pediculosis Association continues to recommend.
“We hear from parents complaining about laxer policies in schools all the time,” said Deborah Altshuler, president of the non-profit association. “When we crafted a no-nit policy in Newton back in the mid-80’s, it was a scientifically-referenced standard that we worked on for over a year.”
The Newton school lice policy now allows children back in school with nits provided they’ve been treated with a medicated shampoo to remove lice.
Shady Hill School, a private elementary and middle school in Cambridge, still has a no-nits policy firmly in place, though the school no longer sends infested students home in the middle of the day.
“We used to send kids home immediately, but now we give parents the option, so they don’t have to miss work, and because we realize the student may have had lice for weeks while in school,” said the school health director Patty Battle-Mutter. Parents, for the most part, are satisfied with the no-nit policy, and Battle-Mutter, a nurse, performs a re-check before allowing students back in school.
“Many schools in the area just want parents to show them an empty bottle of lice shampoo, and I don’t think that’s good enough,” she said.
In fact, about 60 percent of lice that take up residence on children’s heads have become resistant to common over-the-counter chemical treatments, according to a recent study published in the New England Journal of Medicine.
While lice haven’t yet become resistant to newer prescription treatments like malathion (Ovide), insurance companies often won’t cover them. A few years ago, I paid about $100 out of pocket for this treatment when my daughter developed lice a second time because, unlike other treatments, it kills the nits as well as the bugs.
(Malathion is also highly flammable, however, so parents need to be very careful to keep their children away from blow dryers and other heat sources after applying and before rinsing the treatment.)
Frankowski said many insurance companies require parents to first try standard over-the-counter treatments and will only cover prescription treatments if the lice remain alive after the initial shampoo.
While nothing can prevent lice from spreading between kindergartners who love to hug with their heads touching, early detection of the problem can go a long way.
“Lice aren’t easy to find and a 20-second check with popsicle sticks from a school nurse can give parents a false sense of security,” Frankowski added. She’d rather see parents doing longer weekly checks on young kids once a week during bath time or hair-braiding sessions.
“When you catch and treat it early, it’s less of a big deal,” she added.
While disagreeing with many of the pediatrics’ group recommendations, Altshuler did agree with the need for vigilance. “The best policy is to have a community that’s aware of head lice,” she said. “Parents need to know the importance of screening for lice regularly in order to be fully equipped to send their kids to school lice-free.”