Head lice are small parasitic insects that live on the scalp and neck hairs of their human hosts. Head lice are not a health hazard or a sign of uncleanliness and are not responsible for the spread of any disease. Lice move by crawling; they cannot hop or fly. Head lice can occur in schools, especially among younger children. A frequent symptom of head lice infestation is scratching of the scalp. It is the position of both the National Association of School Nurses and the American Academy of Pediatrics that the management of lice should not disrupt the education process.
Children found with live head lice should be referred to their parents for treatment. On the day of diagnosis, the school nurse should contact the parent/guardian and inform the parent/guardian of the presence of live lice. Verbal and written instructions for treatment options should be given to the family of the student by the school nurse. Prompt and proper treatment should be advised. The child may remain in the classroom. There is no research data that demonstrates that enforced exclusion policies are effective in reducing the transmission of lice. School staff needs to ensure that student confidentiality is maintained and should not segregate or in any way embarrass the child. Nursing judgment may prevail in cases of extreme infestation, discomfort level of the child, or skin issues related to scratching.
Upon return to school after being treated, the school nurse should recheck the child’s head. The nurse will continue to work with the family to support treatment and prevent re-infestation. Because no disease process is associated with head lice, schools are not advised to exclude students when nits remain after appropriate lice treatment, although further monitoring for signs of re-infestation is appropriate.
The school’s efforts regarding lice should be limited to educating students, parents, and school personnel with up-to-date information. Unjustified actions include screening children for lice or nits, treating children at school, treating the school building, notifying parents of students who are not infected (such as sending letters to parents of classmates) and excluding from school children who are infested or presumably infested
Divulging the child’s medical condition to the teacher or principal, or to other students and their parents, would be unjustified and would violate confidentiality. Head lice may be an annoyance, but they are neither a serious medical problem nor a public health issue.