Fresh approach to lice means less nit-picking

Posted at 7:00 AM, Sep 25, 2015

Head lice are an itchy, unpleasant nuisance, and many parents of young children have to break out the lice shampoo and nit combs at some point during their children’s elementary years.

(For the uninitiated, a nit is the egg or young form of a louse.)

Recently, the American Academy of Pediatricians and the National Association of School Nurses have come out in favor of allowing kids with lice to remain in the classroom.

Many Tri-State school districts, however, continue to require children to receive home treatment and be deemed lice-free before returning to the classroom. On the other hand, most districts have abandoned the old practice of mass screenings at elementary schools multiple times per year.

Norwood City Schools has a new procedure this year, said Kathy Strasser, Norwood’s district nurse who's also Ohio Director for the National Association of School Nurses.

The district has ended its long-standing practice of checking all preschool- through sixth-grade students three times each year. Nineteen years ago, when Strasser started at the district, those checks would show 18 percent of the student population had lice. Those numbers declined each year – likely because of an effort to educate parents about lice – to just 2 percent last year.

“We are diligent about checking when we need to,” Strasser said. “When we checked three times each year, we were only finding three or four kids, and it didn’t warrant the time and disruption to teachers, so this is the first year we are not doing it.”

When a teacher suspects students may have lice, the nurse or health aide will check them at the end of the day and send them home with a letter about treatment, only to return when they are lice-free. If three children have lice in one class, health staffers will check every student in that class, Strasser said. When lice are found, all parents in that class receive a letter requesting that they be vigilant in checking their own children and to notify the school if they find lice.

Research shows kids are much more likely to pick up lice at home or during sleepovers or camp than in school. But a lot of parents still believe school is where most kids get lice, Strasser said.

Fort Thomas Independent Schools also approaches the issue only when a child shows symptoms. That child will be referred to the office or nurse, where he or she will be checked. If lice are discovered, the school asks a parent to pick up the child from school immediately, if possible, and have the child treated, said Jon Stratton, Assistant Superintendent for Student Services.

The student typically returns the next day and can go back to class if no lice are found. If that child has siblings in the same school or district, Stratton said, the school will check those children as well or notify the school they attend. If a student still has lice after two or three re-checks, the school health coordinator will meet with the family to offer help.

When lice are found, all parents in the student’s class receive a letter notifying them to check their own children.

“We used to check the other students in the class if we found one student with it, but we don’t do that anymore unless a child has symptoms,” Stratton said. “It’s not a real health danger, just a nuisance.”

The American Academy of Pediatrics has updated its guidelines to suggest that no child should be excluded from school because of head lice, and no-nit policies for return to school should be abandoned. Head lice are not a health hazard or a sign of poor hygiene, according to the AAP, and are not responsible for the spread of any disease. Lice crawl; they cannot jump or fly, and are transmitted only by head-to-head contact.

At least one local district, Kings Local, has adopted facets of the AAP and National Association of School Nurses recommendations. When a Kings student is discovered to have lice, the student goes home at the end of the day with chemical treatment recommendations. But he or she is allowed to return to school the next day after treatment without the requirement of being declared completely lice- or nit-free.

The plan helps to minimize the disruptive effects on a child’s educational experiences and the stigmatizing impact the child may feel, said Eva Garchar, school nurse for Kings Junior High and Kings High School.

The AAP's recommendation is still slow to take hold locally, possibly because of the tediousness of ridding lice from hair and the negative feelings parents have about the pests, as well as new research that suggests lice are becoming harder to banish.

A recent study by researchers at Southern Illinois University – Edwardsvillle shows that lice in 25 states -- including Ohio, Kentucky and Indiana -- have become increasingly resistant to typical over-the-counter chemical products used to get rid of them. While those products are still recommended, they may not be as effective for some people.

The AAP suggests contacting the child’s pediatrician in persistent cases of lice for other treatment options.

When lice are discovered in Hamilton City Schools, the child is sent home as usual at the end of the day, and the child’s parents are notified and given treatment guidelines. Students may return to school when they are lice-free, said Joni Copas, director of communications at Hamilton City Schools.

Parents of an entire class are notified if six or seven students in one class have lice, and custodians will give an extra-thorough cleaning to that particular classroom, she said.

“We try to make sure the kids don’t feel ashamed or anything or have a negative connotation, because that’s not fair to the student,” Copas said.

Cincinnati Public Schools addresses lice on a case-by-case basis, said Christine Wolff, CPS communications coordinator. The classroom teachers are considered the first line of defense. They refer a student with suspected lice to the school nurse, who will check the child and notify parents of the presence of lice and how to treat it.

For a single case of lice, there is no need to notify all the parents in a classroom or school, Wolff said. The child is checked for lice again after treatment before returning to school.

If a student at Winton Woods City School District is found to have lice at school, the child will be sent home immediately with parental instructions for treatment. Following treatment, the child may return to the classroom after a school nurse checks that there are no live lice.