How to Manage Head Lice Without Missing School

With kids back in school, parents have to take precautions not only to protect them from COVID-19 but also from a host of other contagions, including the common cold, hand foot and mouth disease, and head lice. However, it turns out that head lice are not as highly contagious as you might have thought.

The latest guidance from the American Academy of Pediatrics (AAP) for head lice in children is pretty different than in the past. It is no longer considered protocol to keep kids at home until they are nit-free. Instead, parents are advised to send their kids to school while treating the lice at home.

Along with advising parents to continue sending kids to school throughout their infestation, the AAP emphasizes the need to de-stigmatize head lice as being the product of poor hygiene.

Where Do Head Lice Come From?

According to the new report from the AAP, head lice have been around throughout the ages. They are parasites that feed on human blood and, when attached to a person, live close to the scalp. Having head lice is a common problem found around the world, regardless of socio-economic status. Treatment in the United States is estimated to cost about $500 million a year.

Head lice don't discriminate between people of different hair lengths, and infestation is not influenced by frequent hair washes or brushing. Head lice can spread from person to person, primarily through head-to-head contact. Rather than hop or jump, lice crawl along the hair.

"Spread can occur during times when kids' heads are in close proximity to one another, such as nap time," says an author of the report, Albert C. Yan, MD, FAAP, FAAD, a professor of pediatrics and dermatology at Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania.

Although lice can occasionally spread through sharing hats, brushes, or pillows, there is generally no reason for lice to leave a healthy head where they live, feed, and lay their eggs—unless they unwittingly crawl directly from one person's hair to another.

New Medications For Head Lice Treatment

The authors of the AAP report stress that treatments for head lice should be safe and age-appropriate—and rid the child of all live lice and nits (eggs). They say it should be affordable and easy to use.

The AAP recommends pyrethroids as a first-line treatment for lice. Pyrethroids paralyze and kill lice and nits. They do not always kill all of the nits, however, so a follow-up treatment may be necessary.

Removing nits with a comb is optional but may be a good idea to help reduce the social stigma. "You can purchase and use a special 'nit comb' to remove any eggs that are attached to the hair closest to your son or daughter’s scalp," says Jonathan Maynard, MD, a pediatrician with Providence Mission Hospital.

Lice can develop resistance to pyrethroids, and the AAP recommends alternative treatments when this is the case. "Newer treatments including non-prescription dimethicone-based treatments and prescription agents such as spinosad can be quite effective," notes Dr. Yan.

You should always get advice from your child's pediatrician if you think they have lice. Self-diagnosis is not always correct, as dandruff or even a stray aphid caught in a child's hair may be mistaken for symptoms of lice. Treatment should be reserved for confirmed cases by a doctor.

Keeping Kids in School Despite Lice

You might be surprised to hear the AAP now recommends keeping kids in school while they are being treated for lice. Some schools have a "no-nit policy," meaning that children must stay home until all nits are gone from their hair. However, experts say children with nits may no longer have active infestations, particularly among those that have been treated. The AAP says no-nit policies may even violate a child's civil liberties. In fact, many health care professionals say no-nit policies should be rejected.

"Sequestering kids at home due to the presence of nits, especially after treatment, is not necessary and deprives children of learning opportunities and raises child care issues for parents of young children," says Dr. Yan. "The isolation of kids from school also heightens the stigma and psychosocial stress associated with the condition."

The AAP indicates head lice screenings in schools have not had a notable effect over time on the number of cases in schools. They say it isn't cost-effective and can even stigmatize the kids who may be suspected of having head lice. Instead, the AAP encourages schools to offer programs for families to help them understand and manage head lice.

The Social Stigma of Head Lice

Head lice are often associated with the idea of uncleanliness, but this is simply not true. "The stigma associated with head lice infestations can be traumatizing to kids and parents," says Dr. Yan. Kids with head lice may be ostracized from their schools, friends, or other activities. It can be a stressful situation for both parents and children.

Normalizing head lice as a common problem will help kids feel less isolated. Head lice can affect anyone, and kids get it through no fault of their own. It is not a serious health risk and it is treatable.

"Though head lice are not considered a medical or public health hazard, kids may feel shame or anxiety about finding one on their scalp," says Dr. Maynard. "Make sure to reinforce that finding these bugs is common, just like catching a cold."