The objective of this presentation is to provide current research based information about head lice and how to manage children with lice in the school.

MANAGING HEAD LICE IN THE SCHOOL

SETTINGA presentation for teachers and parents

Carolyn Genatossio, RN, MPH

This PowerPoint presentation has voice over

Objectives

The objective of this presentation is to provide current research based information about head lice and how to manage children with lice in the school setting.

At the conclusion of this presentation the learner will:

1. Understand what head lice are and how they are transmitted

2. Understand the rationale for the recommendations to not exclude children with lice from school

3. Understand the general principles of prevention and treatment

The “Icky Reaction”

First and foremost it must be acknowledged that when we hear the word “lice” we immediately have the “icky reaction”.

Parents and teachers alike have a tendency to react with great alarm, if not panic, when they hear that they have a child at home or in their classroom who has lice.

In the past, children with lice have been banished from school and advised not to return until they are “nit free”.

Parents have gone to great lengths to rid their child of lice- even resorting to calling a 24 hour hotline and using untested home remedies

School nurses have spent precious time doing classroom “lice checks” and subsequently sending children home who are found to have lice.

The result is that children miss important learning time, parents are needlessly burdened, and school

nurses waste precious time

What are head lice? The head louse, or Pediculus humanus capitis,

is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people

Head lice are small, wingless insects which feed on human blood and live close to the scalp

They need human blood in order to survive Head lice that are off of their human hosts will

starve It is generally believed that a head louse will

not survive for more than 24 hours when off of its human host

Head lice are not known to spread disease Head lice do not thrive on petshttp://www.cdc.gov/parasites/lice/head/schools.html

Learning the lice cycle Live lice lay eggs, these are called nits- you can not

catch nits- they need to be laid by live lice  Nits are small yellowish-white (pearly) and oval

shaped and are glued to the hair shaft at an angle Once laid, it takes 7-10 days for a nit to hatch, and

another 7-10 days for the female to mature and begin laying her own eggs

Head lice are clear in color when hatched, then quickly develop a reddish-brown color after feeding

Head lice are about the size of sesame seeds Head lice have six legs equipped with claws to grasp

the hair Head lice live for approximately 30 days on a host

and a female louse may lay up to 100 nits (eggs).http://www.cdc.gov/parasites/lice/head/biology.html

What are the signs of a lice infestation

The presence of lice is usually detected by the presence of adult live lice, or nits (eggs) attached to the hair shaft

Nits are often at the nape of the neck and behind the ears  Complications of infestations are rare and involve bacterial 

skin infections caused by scratching and subsequent introduction of bacteria normally found on a person’s skin

Itching is the most common symptom of a lice infestation, along with the following additional symptoms:

a tickling feeling or a sensation of something moving in the hair irritability and sleeplessnesssores on the head caused by scratching

Images of head lice

An age old problem

Head lice have been around for thousands of years, evidence of infestations have been found in ancient Egyptian tombs

All children are at risk for head lice Having lice has nothing to do with

hygiene, income, or any other factors except that children are social beings and are therefore at higher risk for getting head lice

How are lice spread?

Lice spread through direct contact They cannot jump or fly – they crawl The most common cause of infestation is direct

head-head contact with an already infected person Lice can survive for short periods on clothing, hats,

hairbrushes, scarves, coats, sports uniforms, bedding, couches, carpeting, pillows, stuffed animals etc. so these can be involved in the spread

Dogs, cats, and other pets do not play a role in the spread of head lice

According to the American Academy of Pediatrics (AAP)

Screening for lice has not been proven to have a significant effect on the spread of head lice in a school community

In addition such screening has not been shown to be cost-effective

Children who are found to have lice eggs (nits) or live lice have most likely been infected for days if not weeks

The AAP recommends that healthy child should not be excluded from or miss school because of head lice, and no-nit policies for return to school should be abandoned.

See more at: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Offers-Updated-Guidance-on-Treating-Head-Lice.aspx#sthash.6LqMzoIP.dpuf

National Association of School Nurses

It is the position of the National Association of School Nurses   that the management of  head lice should not disrupt the 

educational process.  No disease is associated with head lice, and in‐school 

transmission is considered rare When transmission occurs, it is generally found among younge

r aged children with increased head‐to‐head contact       Children found with live head lice should remain in class, but  

be discouraged from close direct head contact with others

http://www.nasn.org/Portals/0/positions/2011pspediculosis.pdf

From a parent who has been there

“Lice are not particularly contagious, they hurt basically no one, and they’re not a public health risk. Lice don’t actually matter”.

Dan Kois, senior editor at Slate and a contributing writer to the New York Times Magazine.

http://www.slate.com/articles/life/family/2014/03/lice_in_school_let_em_stay.html?wpisrc=burger_bar

Treatment- general guidelines

It is recommended that you consult a health care provider about treatment

Treatment for head lice is recommended for persons with an active infestation

All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated

Some experts believe prophylactic treatment is prudent for persons who share the same bed with actively-infested individuals.

All infested persons (household members and close contacts) and their bedmates should be treated at the same time

http://www.cdc.gov/parasites/lice/head/treatment.html

Treatment

Treatment for head lice usually consists of shampooing the hair with a medicated shampoo containing one of the following ingredients: permethrin, pyrethrin, malathion, benzyl alcohol, spinosad, or ivermectin.

Shampoos containing lindane are no longer recommended.

Hair should be checked daily for the 10 days following treatment for newly hatched head lice. If these are present, an additional treatment may be necessary. Many of these agents require a reapplication of the treatment 7-10 days later to kill immature lice that may have hatched from eggs that were not inactivated during the initial treatment

Treatment

Before shampooing remove clothing that can become wet or stained during treatment

Apply lice shampoo, also called pediculicide, according to the instructions contained in the box or printed on the label.

If the infested person has very long hair (longer than shoulder length), it may be necessary to use a second bottle. Pay special attention to instructions on the label or in the box regarding how long the medication should be left on the hair and how it should be washed out.

Treating the environment

Machine wash and dry clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle.

Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for 2 weeks

Vacuum the floor and furniture, particularly where the infested person sat or lay

Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin

Take these steps to help prevent and control the spread of head lice

Avoid head-to-head (hair-to-hair) contact during play and other activities at home, school, and elsewhere (sports activities, playground, slumber parties, camp)

Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes

Do not share combs, brushes, or towels. Disinfest combs and brushes used by an infested person by soaking them in hot water (at least 130°F) for 5–10 minutes

Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person

http://www.cdc.gov/parasites/lice/head/prevent.html

The experts agree

Routine screening is not cost effective and has not proven to have a significant effect on the spread of head lice in a school community over time

No child should unnecessarily miss time from learning

No healthy child should be excluded from or allowed to miss school time because of head lice

A No-nit policy for return to school should be abandoned

References

Andresen, K. & McCarthy, A. (2009).  A policy change strategy for head lice management.  The Journal of School Nursing, 25(6), 407-416.

Gordon, S.(2007).  Shared vulnerability:  A theory of caring for children with persistent head lice.  The Journal of School Nursing, 23(5), 283-292.

Pontius, D. (2011).  Hats off to success:  Changing head lice policy.  NASN School Nurse, 26(6), 356-362.

Weisberg, L. (2009).  The goal of evidence-based pediatric guidelines.  NASN School Nurse, 24(4), 165-166.

References and Resourcesto view links right click on the links and

click open hyperlink

http://pediatrics.aappublications.org/content/126/2/392.full?sid=d84bd3b5-304f-4b8e-bf40-be2c7c1a35cb

http://www.slate.com/articles/life/family/2014/03/lice_in_school_let_em_stay.html?wpisrc=burger_bar

http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/40/Pediculosis-Management-in-the-School-Setting-Revised-2011

http://www.cdc.gov/parasites/lice/head/schools.html

Resources

http://www.bostonglobe.com/lifestyle/health-wellness/2013/11/18/school-head-lice-policies-need-update/WeTYItmzgaPwNB2W4a6bmK/story.html

The National Association of School Nurses has many resources including handouts for teachers and parents http://www.nasn.org/toolsresources/headli

cepediculosiscapitis/licelessons