Head Lice

1. Head Lice Presented by: The Glen Ridge Board of Health

2. Contact Information • Borough of Glen Ridge (973)748-8400 • Glen Ridge Board of Health • Donna Lifson, MD – President • Jacqueline Yustein – Vice President • Sujana Chandrasekhar, MD • Elizabeth Baker • Deborah Priestman, RN • Mike Sherman, PhD • Chris Valerian, MD • Donna Heinzen, PA

3. Policies • Glen Ridge currently joins many other school districts and day care centers to enforce a “no-nit” policy, requiring that children be excluded from school until they are “nit-free.” • Due to scientific evidence and research that shows “no-nit” policies are ineffective in controlling transmission of head lice, the following entities do not support or recommend them: • US Centers for Disease Control • American Academy of Pediatrics • National Association of School Nurses • The State of Michigan’s non-exclusionary lice policy is effective in preventing the spread of head lice, while keeping children in school. • The Glen Ridge Board of Health therefore recommends that policy changes be made to allow children back to school once treatment has been initiated.

4. Impact of Exclusion (no-nit) Policies • 4-8 million children in the US are over treated each year. • 12 to 24 million school days are lost annually. • Missed workdays cost by parents having to stay home with their child costs $4-8 billion annually. • Psychological impact to child and parent caused by teasing and/or anger directed at infested child/family. • Anxiety over head lice often leads to inappropriate treatments that pose health hazards to child and household.

5. What are head lice? • Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood. They cannot jump or fly and do not burrow under the skin. • Head lice are not known to spread infectious diseases from person to person and should not be thought of as a medical problem. • Head lice are certainly a nuisance, but they are not generally considered a health hazard. • They lay up to six eggs per day, attaching the eggs (called nits) to strands of hair close to the scalp. • Generally, nits found more than ¼ of an inch from the scalp are dull yellow in color and no longer carry a live louse.

6. Empty nit case Viable nits Hair spray droplets Dandruff Hair casts

7. Centers for Disease Control and Prevention (CDC) School Guidelines • "No-nit" policies that require children to be free of nits before they can return to school should be discontinued: • 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. • Misdiagnosis of nits is very common during nit checks conducted by non medical personnel. • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice. www.cdc.gov/parasites/lice/head/schools.html Updated November 2010

8. American Academy of PediatricsHead Lice Guidelines, Aug 2010 • Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease. • No healthy child should be excluded from or miss school because of head lice, and no-nit policies for return to school should be abandoned. • Informed school nurses can help with diagnosis and suggestions about treatment. • Because head lice are usually transmitted by head‑to‑head contact, parents should carefully check a child’s head before and after attending a sleepover or camp where children share sleeping quarters. aappolicy.aappublications.org/cgi/content/full/pediatrics;126/2/392

9. National Association of School NursesNit Free Policies in the Management of Pediculosis It is the position of the National Association of School Nurses that nit-free policies disrupt the education process and should not be viewed as an essential strategy in the management of head lice. DESCRIPTION OF ISSUE: Families and school staff expend innumerable hours and resources attempting to eradicate infestations, expending equal efforts on live lice and their nits. RATIONALE: Rarely, if ever causing direct harm, head lice are not known to transmit infectious disease person-to-person. Furthermore, current research does not support the conclusion that enforced exclusion (nit free) policies result in reduced transmission of head lice. Adopted: November, 1999 http://www.nasn.org/positions/nitfree.htm

10. Michigan School Head Lice Prevention and Control Policy • Any student with live lice may remain in school until the end of the school day. • Immediate treatment at home is advised. • The student will be readmitted to school after treatment and examination. If, upon examination, the school-designated personnel finds no live lice on the child, the child may reenter the school. • Any student with nits (farther than ¼” from scalp) should be allowed in school. • Parents should remove nits daily and treat if live lice are observed.

11. Michigan School Head Lice Prevention and Control Policy, cont’d When member of school staff suspects a child has head lice: • Restrict child from activities involving close contact (i.e. hugging) or sharing personal items with other children. • Notify school/facility administration. • Contact parent (verbal communication preferred). Immediate removal of the child is unnecessary. The child can be sent home at the end of the day (allowed to ride school bus home). • A letter should be sent home to notify classmate’s parents that a case of head lice is suspected, asking them to check all of their children. • Provide information sheet on head lice infestation and treatment. • http://www.michigan.gov/documents/Final_Michigan_Head_Lice_Manual_103750_7.pdf

12. Who recommends No-Nit Policies and exclusion of children from school? • National Pediculosis Association – www.headlice.org • Sells the LiceMeister™ comb. • Mission statement equates lice and nit control to “responsible personal health behaviors” and “a commitment to health and wellness.” • Contradicts CDC, AAP, NASN guidelines. • No clinical relevance. • No data to support the claims.

13. Conclusions • Although Glen Ridge is among many school districts and day care centers that enforce a “no-nit” policy, this policy is not supported by scientific evidence or research. Nor is it supported by: • US Centers for Disease Control • American Academy of Pediatrics • National Association of School Nurses • Furthermore, a “no-nit” policy is not in the best interests of the borough’s children, as it can lead to: • Excessive school days missed. • Unnecessary stigmatization and anxiety. • Therefore, the Glen Ridge Board of Health recommends that the Glen Ridge Board of Education change its current policy, to allow children back to school once treatment has been initiated. • The Glen Ridge Board of Health proposes the formation of a joint subcommittee between the BOH and BOE to implement a changed policy in order to allow children back to school once treatment has been initiated.