Head lice infections are very common among school-aged children. According to the Centers for Disease Control and Prevention (CDC), an estimated 6 to 12 million infestations occur each year in the United States among children 3 to 11 years of age. With numbers this high, many parents wonder why schools don’t just send kids home when they have lice.
What are head lice?
Head lice are tiny wingless insects that live and breed in human hair. There are three forms of head lice:
- Nits – Head lice eggs
- Nymphs – Immature lice that hatch from nits
- Adult lice – Mature lice that can lay eggs
Head lice feed on human blood several times a day and live close to the human scalp. They are not known to spread disease. An infestation of head lice is commonly referred to as pediculosis.
How are head lice transmitted?
Head lice are spread mainly through direct head-to-head contact. Less commonly, they can spread through contact with personal belongings like hats, brushes, headphones, or other items that have been in contact with an infected person’s hair.
Lice do not fly or jump. They also cannot survive for long once detached from the human head. They need the warmth and humidity found close to the scalp in order to thrive.
What are the signs and symptoms of lice?
Signs and symptoms of head lice include:
- Itching in the affected area (often the back of the neck and behind the ears)
- A tickling feeling on the scalp
- Irritability and trouble sleeping – head lice are most active at night
- Sores on the head caused by scratching
- Finding live lice or eggs (nits) in the hair
How are lice diagnosed?
If lice infestation is suspected, the diagnosis can be made by looking closely through the hair and scalp for live lice or eggs. Schools may have designated staff members trained to check students’ hair for lice.
Nits (lice eggs) are teardrop shaped and attach to the hair shaft. They are often found around the nape of the neck and behind the ears. Nits may be confused with dandruff, but they cannot be easily removed or brushed off.
Can lice spread in schools?
Yes, head lice can spread easily in school settings where children are in close contact throughout the day. Shared items like headphones, helmets, hair accessories, costumes, and more can also contribute to lice transmission.
Some of the reasons lice spread so readily in schools:
- Frequent head-to-head contact between students in play, sports, nap time, etc.
- Coat/backpack hooks and cubbies kept close together in classrooms
- Trying on costumes and sharing dress-up clothes
- Shared headphones, helmets, hairbrushes, etc.
- Hugging, touching heads
Why aren’t all schools “no nit” policies?
“No nit” policies in schools require children to be free of lice eggs in order to return to class. Some schools used to enforce strict no nit policies, but have moved away from this approach over time. There are a few reasons for this change:
- Missing class time: No nit policies often result in students missing excessive amounts of class time in order to be repeatedly checked or treated. This disrupts their education.
- Social stigma: Strict policies could lead to embarrassing and unnecessary exclusion of students suspected of having lice.
- Lacks evidence: There is little scientific evidence showing that no nit policies significantly reduce lice transmission compared to more relaxed approaches.
- Requires resources: Checking every student regularly for the presence of eggs requires designated staff and time commitment.
What do pediatricians recommend?
Many pediatricians argue that no nit policies cause more harm than good for students. The American Academy of Pediatrics recommends the following approach:
- Children diagnosed with live head lice should be treated promptly.
- Nits may persist after treatment but those nits are unlikely to hatch.
- Classroom or school-wide screening is not an effective way to curb lice transmission.
- Children should not be excluded from class for nits alone after appropriate lice treatment.
This approach minimizes missed class time and social stigma while still containing manageable infestations.
What are some school lice policies?
School policies on head lice vary between districts. Some examples of different approaches:
| Policy | Details |
|---|---|
| Zero tolerance no nit policy | Students with nits or lice are excluded from school until they are nit-free |
| Modified no nit policy | Students are checked periodically for nits but only excluded if live lice are found |
| Exclude active infestations only | Students are sent home if live crawling lice are found but allowed to return if treated even if nits persist |
| Passive screening | Class-wide or school-wide screening is not routine. Students are checked only if symptoms are reported. |
Some nurses argue that nit removal should be emphasized over exclusionary policies to contain lice spread.
When can children return to class?
Guidelines often state that students may return to class after one appropriate lice treatment if:
- No live, crawling lice are present
- They have been checked by a school nurse or administrator
- Proof of treatment has been provided
- Nits may still be present after treatment but pose low risk to others
A second lice treatment is often recommended 7-10 days later to kill any newly hatched lice before they can mature and lay eggs. Diligent combing between treatments can help remove leftover nits.
How are schools responding to lice?
Many school administrators understand lice are common and do not pose significant health risks. Some approaches adopted by schools include:
- Educating families on lice detection, treatment, and prevention
- Training staff to identify live lice properly so students aren’t excluded unnecessarily
- Avoiding language that stigmatizes or embarrasses students with lice
- Allowing classroom return after treatment and re-examination if no live lice are found
- Abiding by evidence-based control measures recommended by experts like the CDC and American Academy of Pediatrics
What role do parents play?
When head lice are detected, parents should:
- Inform the school and any close contacts of their child
- Treat their child with an effective lice-killing product before returning to class
- Comb hair thoroughly with a nit comb to remove nits
- Avoid exposure for all close contacts during treatment
- Wash bed linens, clothes, brushes, towels, and other items in hot water
- Repeat shampooing or combing after 7-10 days to catch any newly hatched lice
At school, parents can encourage administrators to adopt evidence-based, non-stigmatizing approaches to managing head lice.
Conclusion
Head lice are a common nuisance in elementary schools, where children are in close contact. While lice do not pose significant health hazards, they spread readily in this environment through head-to-head contact.
In the past, strict no nit policies kept children with lice eggs out of school for extended periods. But public health experts increasingly recognize these policies are not effective and instead stigmatize children and disrupt learning.
Leading medical groups like the American Academy of Pediatrics encourage schools to discontinue no nit policies. They advise allowing classroom return once live crawling lice are treated, even if some nits remain. This minimizes exclusion while focusing on treatments that kill live lice to prevent further spread.
With a coordinated approach among administrators, teachers, school nurses, and parents, lice can be managed without depriving students of class time. Evidence-based policies that avoid shaming children are key to containing infestations while maintaining a positive learning environment.