Should Kids With Head Lice Or Nits Be Barred From School?

Summer was slow for Ray Ruiz.

"Kids were out school. We did not see much lice in the summer," said Ruiz, the managing partner of Nit-Wits Lice Treatment, based here in the East Bay suburbs. His company has been doing personal screening for lice infestation and removal for individuals and schools in the Bay Area for 10 years.  

But he expects business will start to pick up now that school has started. Students, especially young students, will once again come into pretty close contact with one another in the classroom. They will even share items like combs, hats, and clothing--items that can spread lice. "We are already going to screen two schools in Walnut Creek," Ruiz said. 

Walnut Creek schools are bracing for, yes, a lousy problem: Another school year marked by outbreaks of head lice. These parasitic crawling insects, of 1/32 to 1/16 of an inch, can cause intense itching of the scalp, neck and shoulders and be difficult to eliminate from the individual or his home.  

While head lice are annoying, they do not lead to serious medical problems, and they do not carry or spread disease. Nonethless, it is common for schools, including schools in Walnut Creek, to send students home if they are found either with "nits"--lice eggs laid by adult females at the base of the hair shaft--or with an active infestation.

The American Academy of Pediatrics would like to end the practice of forcing kids to leave school. The Academy says that bad science and old-fashioned stigma are wrongly causing students to miss valuable classroom time. 

Indeed, the Academy notes that international head lice guidelines, established in 2007, have stated that stated that no-nit policies are unjust and should be discontinued, because they are based on misinformation rather than objective science.

"Head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work, and millions of dollars spent on remedies," the Academy reported. 

Personal hygiene or cleanliness at home or in school--or lack thereof--has nothing to do with getting head lice, adds the Centers for Disease Control and Prevention. Head lice are found worldwide, with an estimated 6 million to 12 million infestations each year in the United States among children 3 to 11 years of age. 

These infestations are most common among preschool children attending day care, elementary school children, and household members of infested children, the CDC says.

The Academy made several findings about school control measures and argues that zero-tolerance policies for both nits and active lice infestations should be reconsidered.

• Screening for nits alone is not an accurate way of predicting which children will become infested, and screening for live lice has not been proven to have a significant effect on the incidence of head lice in a school community over time.
• Less than one third of children with nits developed lice infestations, and only about a third of those with a higher concentration of nits in a single area were likely to develop an active infestation.
• School exclusion of children with nits alone results in many children missing school unnecessarily. Several descriptive studies suggest that educating parents in diagnosing and managing head lice may be helpful.
• Among sampled elementary schools implementing a "zero-tolerance" program, one school reported students dismissed for infestation missed an average of 20 days at school.
• As for a child with an active head lice infestation, he or she has probably had the infestation for a month or more by the time it is discovered and therefore poses little risk to others. If he or she does not have a resulting health problem, that child should remain in class but be discouraged from close direct head contact with others.

Considering this report, the two school districts that serve K-8 students in Walnut Creek had varying responses.

"The district certainly agrees with the report," said Dan Walden, a long-time board member at the Walnut Creek School District. He said the Walnut Creek district changed its policy from a no-nit to a no-lice three years ago.

Walnut Creek schools will send students home if they are found with "active and adult head lice." The student will be allowed to return to school the next day and will be checked by the nurse or designee before returning to class. The students also must be checked weekly for up six weeks once they are determined to be free of lice.

The Mount Diablo Unified School District's sticks to the "no nit" rule.

"We decided not to make any changes in our policies or procedures," said Gary Eberhart, vice president of the MDUSD Board of Education. Five years ago, he said, the district worked with their nurses to review their policies and procedures, and concluded their no-nit policy worked fine.

Asked if the district would consider adjusting its policies, based on the American Academy of Pediatrics recommendations, Eberhart said the school district is not currently considering any policy changes.

However, he said, if parents express concern about the policy, especially in light of the Academy's recommendations, "we would entertain that possibility if there is overwhelming support to do so."