School Policies on Head Lice May Be Overkill

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May 9, 2001 -- Head lice - just the thought of having bugs living in your or your child's hair sends a shiver up your spine. Such revulsion is part of the reason that school policies for eliminating head lice and preventing their spread are often extremely stringent. But some of these rules might actually be too severe, according to recent evidence.

Head lice are small insects called Pediculus humanus that sometimes take up residence on the head and neck of humans. According to L. Keoki Williams, MD, the author of a new study published in this month's issue of Pediatrics, "as many as six to 12 million persons are affected annually [with head lice]".

Head lice can be a problem, especially among children, because they pass them to each other through direct head-to-head contact or by sharing items such as hats, combs, or even furniture and bedding. Head lice can strike anyone; it is not an indication of a lack of good personal hygiene or poor parenting.

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While head lice do not cause serious health problems, they are annoying and do make the scalp itch. This itching can affect sleep and school performance, so it is important that lice be treated. While being treated, children with lice often must stay home from school to prevent the spread of the condition to other children.

Children with just the egg casings, called nits, are also treated, despite the fact not all nits become lice. In addition, Williams says, "nits, or egg casings, can persist in the hair long after an infestation with lice has been successfully treated." Still, because of the concern that children with nits will develop lice, many schools have adopted a "no nit" policy.

But is it necessary for a child to stay out of school if he or she just has nits?

To find out, Williams and his colleagues screened 1,729 children in two metropolitan Atlanta elementary schools for head lice. They found that 28 of the children had lice whereas 63 had nits without lice.

The researchers then followed 50 of the 63 children with nits only to see if they developed head lice. Within the 14-day follow-up period, only nine children went on to develop head lice.


"Our study confirms that few children (18%) with nits became infested over the follow-up period," says Williams. "Based on these findings we suggest that children with nits and no crawling lice be followed and examined regularly, rather than be excluded from school. Additionally, in the absence of signs of crawling lice, we suggest that children with nits alone not be treated with medication, but rather followed and nit removal encouraged."

At the time he performed the study, Williams was with the Epidemic Intelligence Service in the Division of Applied Public Health Training at the CDC, as well as with the Georgia Division of Public Health, both in Atlanta. He is now a lecturer in Internal Medicine at the University of Michigan in Ann Arbor.

Two experts, Richard J. Pollack, PhD, and Anthony E. Kiszewski, DSc, tell WebMD that there are some problems with the study, notably that it's not clear whether the children with nits went on to develop lice because of an ongoing infestation or because they caught a new set of lice from contact with friends of siblings.

However, they do agree with the conclusions of the study regarding how to handle head lice in schools. Pollack is an instructor in immunology and infectious diseases and Kiszewski is a research associate in the department of immunology and infectious diseases, both at the Harvard School of Public Health in Boston.

Pollack's recommendations for getting rid of head lice are the following:

  1. Be sure your child has live lice in his/her hair. Do not treat a child unless you see bugs walking around on the head. Children with only nits should be reinspected a week or so later.
  2. Use a fine tooth louse comb combined with an over-the-counter medicated shampoo to get rid of live lice. If you still see live lice a few days later, treat again.
  3. If you still see live lice after these two treatments, visit your doctor, who can prescribe a stronger remedy.
  4. There is no need to clean your house if someone in the household has lice. The most you need to do is throw the pillowcases and stuffed animals of the affected person in the dryer.

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