Schools shouldn’t be bugged about head lice, doctors say

They’re some of the creepiest, crawliest bugs out there. But pediatricians are urging reason over emotion when it comes to reaction toward head lice, saying that the bugs are a mere nuisance and don’t justify suspension from school or a rush toward prescription medication. Updated recommendations from the American Academy of Pediatrics being published today in the journal Pediatrics reinforce the AAP’s earlier recommendations that students not be sent home from school if lice are discovered.

“From a public health

standpoint, children do not need to be excluded,” said Cynthia DiLaura Devore, lead author of the report and immediate past chairwoman of the AAP’s Council on School Health. She added that day care centers also should not exclude children.

The AAP recommends that if lice are found on a student at school, that student should be allowed to finish the school day. Though the AAP urges treatment as soon as possible, the report says that “a child should not be restricted from school attendance because of lice.”

Pennsylvania Department of Health regulations require schools and school districts to exclude students if they’re suspected of having live lice. They are allowed to finish the school day and are to be readmitted to school immediately following the first treatment. The schools, however, can also choose to adopt other policies.

The topic of lice does not seem to be one that local school districts are particularly chatty about, with five districts — Pittsburgh, Avonworth, West Jefferson Hills, Bethel Park and Brentwood — declining to respond to questions about their lice policies.

In the North Allegheny School District, the school nurse and principal decide how to proceed, spokeswoman Mary Marous said. An email is sent to parents who have students at the school but neither the individual class nor grade level is identified. The student is allowed back in school after the lice is treated, with evidence of the medication or its packaging required as proof.

“The district’s goals are for head lice to have minimal disruption to students’ educational experiences and minimize the stigmatizing impact on students and families,” a school district statement on head lice stated.

Local districts have different approaches to lice, with some districts “more lenient than others,” said Jason Webber, owner of the Center for Lice Removal in Green Tree. The salon, which charges $95 or $135 for nit picking combing treatments, sees clients from all over the Pittsburgh area. Business has doubled each of the three years that it has been open, said Mr. Webber.

Even when removal from a classroom is practiced, it’s often not particularly effective for controlling the spread of lice, said Dr. Devore.

“By the time a child is diagnosed with having head lice, often they’ve already had the head lice for weeks,” she said, noting that children need to develop a sensitivity to the bugs before they develop itchiness and other symptoms.

Lice rarely jump from head to head, she said, and are more likely to spread at slumber parties or sleepaway camps than in a school setting.

The AAP recommends that lice be treated first with an over-the-counter medication, perhaps followed by manual nit removal. Only if lice persist after three applications of an over-the-counter medication (taking roughly 20 days) should a pediatrician be contacted for prescription medication, Dr. Devore said.

Since 2010, when the AAP last put out recommendations, two new prescription medications — spinosad and ivermectin — have been approved to fight lice.

“What I hope this updated report will do is remind people that lice are a nuisance,” Dr. Devore said. “They’re not a public health problem in the way that other things are.”