Should Head Lice Keep Kids Out of School?

Mom Combing Out Head Lice
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If your children have ever had head lice, you probably flinch every time they scratch their head. Could it be those blasted bugs again? One bout with medicated shampoos and washing everything in the house and picking through hair strand by strand looking for nits ... the only thing worse than having to wage an all-out war to remove every last trace of louse life is knowing that your child won't be able to go back to school until you do.

And why is that? Do head lice spread disease? Do they cause injury? Do they fly about the room and land on everything in sight? Do the nits somehow pass from child to child like live bugs?

In a word: No.

So why are children being excluded from school merely for having a few louse eggs stuck to their hair shafts? As much as enforced school absence is an inconvenience for children in regular education, it's a disaster for children with special needs, who miss out on needed school-provided therapies, react badly to the change of routine, may have life-threatening reactions to pesticide shampoos, and are neurologically unable to sit still for nit-picking. As one mom of a sensory integration disordered boy lamented, "If my son gets head lice, I'll just have to start home-schooling him."

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Background

Head lice are no buggies-come-lately. They've been around since prehistoric times and are perfectly evolved for a living, feeding, and reproducing atop the human head. Live lice lay their egg, or nits, on the hair shafts and glue them on good. Since they need regular meals of human blood to live, lice don't survive much more than a day without a head to suck on.

Happily home in your hair, however, a louse can live for about a month and produce 100 offspring.

Head lice are often thought to be an indicator of poor hygiene, but they're perfectly comfortable on clean heads. They're often thought to be a sign of poor parenting, but parents are more likely to harm kids by overdoing it with pesticide shampoos than by not preventing infestation in the first place. They're often thought to leap from a bug-filled head to a bug-free one, but these are crawling insects, not jumping or flying ones. What having head lice mostly means is that somewhere within the past month, your head has touched the head of someone with lice, and an opportunistic critter has walked on over.

And since the most likely place for kids to bump noggins outside the family is at school, classrooms have become the front lines of head-lice resistance. If children's educational opportunities and parents' mental health have to be sacrificed along the way, well, nobody said  was pretty.

No Nits, No Compromise

A "No Nits" policy is the school nurse's version of Zero Tolerance: Any sign of lice -- living, dead or gestating -- and you're out of there. If you're looking at things from a purely pest-control perspective, that makes a lot of sense. The only good head is a clean head. Nits may not be a threat while they're in that form, but they'll eventually hatch out as lice, and who knows the exact moment that will occur?

Better safe than sorry.

The leading proponent of that position is the National Pediculosis Association, which stands unwaveringly by the conviction that the only way to stop the cycle of lice infestation and reinfestation is to keep kids out of school until every last nit is picked. Any less-consistent policy is just a recipe for more lice, more missed school, more pesticide shampoo, and more pesticide-resistant bugs. According to an NPA press release, "Industry-sponsored guidelines developed in 2000 to promote sales of pesticide treatments for head lice continue to be used as the basis of allowing lice infested children to remain in the classroom. Parents across the country are fighting back!" Policies that keep nit-headed kids out of classrooms are necessary, the association says, to maintain community standards, teach kids about good health habits, urge families toward responsibility, and reduce the need for chemical treatments.

That certainly sounds reasonable. Who would argue with the firm handling of a public health crisis?

No Nits? No Need

Well, the American Academy of Pediatrics, for one. Also the National Association of School Nurses (NASN), and a public health entomologist affiliated with the Harvard School of Public Health.

Their argument is that head lice are not a public health crisis at all, not harmful to anything but our delicate sensibilities, and that, therefore, kicking kids out of school to keep lice at bay is an unnecessary overreaction. It's made worse by the fact that truly determining a child is nit-free -- without mistaking things like dandruff, lint, and dead nit remnants for actual eggs -- is a tricky and oft-mishandled process.

The NASN's position statement tallies up some of the cost of head-lice hysteria: "Embarrassment and social stigma frequently accompany identification of infestation. Schools may be blamed as the source of contraction for students. Historically, in an effort to decrease head lice infestations, many U.S. schools adopted 'no nit' policies. Subsequently, schools report extended student absences related to chronic infestation in certain students. Study of attendance records found 12 to 24 million school days are lost annually in the U.S. due to exclusion of students for nits ....

Exclusion from school for any reason has been correlated with truancy ... as well as with poor academic performance."

In the end, it appears that the only real harm a head louse does is to keep a kid out of school. And if that's so, is keeping kids out of school the best way to solve the problem? Are parents going into frenzies of chemical use and house cleaning and hair pulling to get rid of bad bugs, or to get kids back in school? If lice didn't result in missed classes, missed work, social judgment and the potential for disrupting the lives of one's peers, would we even care all that much about them? It's worth noting that, while the opponents of No Nits policies may be following guidelines set by shampoo manufacturers, the proponents of No Nits policies are selling nit combs.

Where It Stands

Lest you think this doesn't apply to your special-ed child, since the IDEA provides a legal right to schooling and compensatory education will have to be provided if the administration tries to exclude him or her, think again. A Pennsylvania court, in denying compensatory education to a disabled student kept out of school 19 days due to a head lice infestation, ruled that IDEA protections that apply if a child in special education is expelled or suspended for more than 10 days due to behavior problems are not required if the same child is kicked out as the result of a No Nits policy. So No Nits isn't really the health equivalent of Zero Tolerance -- it's stronger.

Given that, and knowing of the difficulties that parents of students with special needs may have in ridding their children of all traces of head lice, is it paranoid to worry that administrators may stop fighting to remove troublesome special education students through disciplinary actions and just start dropping bugs in their hair?

Where does your opinion lie on lice? Should schools be able to keep kids out indefinitely to prevent bug breakouts? Stop by the Parenting Special Needs Forum and sound off. Then share your favorite strategy for getting rid of the little buggers.

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