Head Lice Information
Lice are fairly common wherever groups of people get together, including the school setting. Many people have concerns about the spread of disease with head lice, but these insects do not spread disease. They do, however, live by biting the scalp and eating the blood that comes from that bite, which causes some itching, and sometimes sores if the scratching gets really bad. Those sores caused by the scratching can become infected, which causes a bigger health problem than the head lice themselves. Having head lice is not a matter of being dirty or having poor hygiene. Lice simply look for the opportunity to get to anyone’s head that they can crawl to. Lice cannot fly or jump…they crawl, and they prefer to stay on people’s heads where they get food.That’s why early detection and treatment is very important, and why we require that children who have evidence of the head lice must stay home from school until that evidence is gone. Your child’s school nurse is a great resource for answering questions about head lice. Because it is a fairly common condition in public places where large numbers of people gather, school nurses have a lot of experience in dealing with head lice, and can help make the best decision about when students should be sent home when this condition is seen.
We can tell that people have head lice from either seeing the live insects in the hair (they are very fast…you have to look hard to see them) or by seeing their eggs attached to the hair. Those eggs are called “nits” and are very firmly attached to the hair shaft by a cement-like glue. You can tell nits from other things in the hair, like dandruff or other deposits on the hair such as hair casts or sprays, gel, etc. by the shape of them, and because they don’t move when the hair is moved…they are very tiny almond-shaped specks and they are stuck firmly to the hair. Those eggs hatch out into adult lice every 7-10 days, adult lice live for about 20-30 days, and each female insect can lay up to 50 new eggs during that time!Lice are very common in groups of children and are unfortunately on a rapid increase due to the fact that they are becoming resistant to all the treatment products on the market.Lice are tiny insects about 1/16"-1/8" long and are dark gray to brown in color. They do not hop or fly, but can move quickly through the hair. More commonly, you may see the nits (lice eggs). They are very tiny, white to brown in color and are glued tightly to the hair shaft close to the scalp, particularly above the ears and at the nape of the neck. Nits will hatch in 7-10 days and begin laying more eggs - around 50 per bug very quickly after hatching. This is why early detection and treatment is so important. An itchy head or rash at the nape of the neck may be your first signs of lice.Texas law states that pediculosis (head lice) is a condition that requires that exclusion from school until treatment has been done.Just click on any of the following for information on how we follow that law in Denton ISD:Our standard of practice for Denton ISDSome great information from the Texas Department of State Health ServicesIt takes cooperation from the school and home to manage this problem. At home, frequent checking and notifying the nurse at school when you find lice will help to control the problem. When lice are found, you must treat according to directions from your physician or from the school nurse. The nures will be happy to answer questions about lice and help you identify them, as well as give you lots of information to help prevent a recurrence of the problem.
: Health Services Department Denton Independent School District ISD Health Services Standard of Practice: Denton
Management of Pediculosis in the School Setting
School RNs will screen students for pediculosis on an individual student basis as the preferred method. Entire classroom evaluations and routine screenings are generally not productive and result in a potential loss of privacy, embarrassment for students, and decreased instructional time due to classroom disruption.
Screening is performed in the health room in a confidential manner, upon referral of a student or students by themselves, their parents, and/or school personnel. Referral is based on these symptoms of pediculosis:
- frequent scratching of the head and/or back of the neck
- pink to red marks on the scalp and/or back of neck
- unexplainable sores and/or scabs on the scalp/back of the neck
- yellowish white or brown eggs (nits) attached to strands of hair that can't be washed out or flicked off with the finger
- white to gray crawling forms about the size of a sesame seed
(in advanced cases the adult lice are larger and are a darker color, and they move quickly through the hair when the hair is parted)
Classroom screenings may be performed on occasion at the request of the campus principal when there is concern that an infestation may be more widespread than one or two students.
When classroom screenings are done, the nurse and teacher will collaborate on a plan prior to the screening that will allow identification of any positive cases without exposure of findings to other students.
Nurses new to school health will undergo training at the beginning of the school year with experienced school RNs to learn appropriate screening procedures based on guidelines from the Texas Department of State Health Services and DISD protocol.
In the event of identified infestations, the school nurse will notify the parent/guardian of the infested child by phone or email if possible, and by parent letter sent home.
On occasion, if two or more students in the same classroom are found to have active cases of pediculosis, a general information letter may be sent out to parents/guardians of all students in that classroom. These letters are done at the discretion of the campus principal with input from health services. Recurrences of pediculosis in that classroom do not require that another letter be sent out, as the information is the same.
Under no circumstances will a school official disclose to any other parent or guardian the name(s) or private health information of affected students.
law, students who have evidence of active pediculosis (the presence of live adult or nymph lice, and/or nits that are visibly noted to be closer than ¼ inch to the scalp) will be excluded from school that day so that treatment may begin as quickly as possible. Students may remain in the classroom until parents can pick the child up; the classroom teacher can monitor close contact (head to head) with other children until that time. If a student is unable to be picked up until the end of the day, the nurse will make contact with whomever is taking the child home to address the issue of minimizing close contact with other children and to ensure that the parent letter is passed on. Texas
The nurse will also contact the school RN for any school-age siblings/others who live in the home so those students may also be assessed.
Students who have signs of past infestations or previously treated infestations (presence of nits that are farther away from the scalp than ¼ inch with no evidence of live lice) do not have to be excluded from school. The nurse will notify the parent/guardian of her assessment and provide them with information on the removal of nits.
Our exclusion protocol is designed to protect the integrity of the school day, and to minimize embarrassment and unnecessary isolation of students with pediculosis. It is founded on evidence-based practice and recommendations from the Texas Department of State Health Services, the
of Pediatrics, the National Association of School Nurses, and the Harvard School of Public Health. American Academy
Students who have been excluded from school for active pediculosis must be examined by the school RN prior to readmission to the classroom. The nurse will assess for efficacy of treatment and will readmit the student to the classroom when no signs of active pediculosis are present.
Students who have nits that are all farther than ¼ inch from the scalp and no signs of active pediculosis must show daily signs of progress being made in nits removal to remain in class.
No treatment protocol is 100% effective to prevent reinfestation, and it is difficult to monitor what treatments have actually taken place in the home. Daily progress in removal of nits is an assurance that the condition is being monitored and cared for, and a protective measure to minimize the chance of exposure to other students. The school nurse will check the student at least twice each week to determine level of progress, and communicate with the parents the results of her assessment.
Although time-intensive, the recommended treatments for pediculosis are inexpensive and relatively easy to perform. Students absent more than two full school days for pediculosis will have a follow-up call from the school nurse to assess progress and any additional needed resources. At that time, the principal or his/her designee will also review Texas Compulsory Attendance laws with the parent/guardian to assure compliance with those laws, and will submit to district attendance officers any concerns for excessive absenteeism.
Awareness and Education:
In addition to the parent notification statements above, the school nurse will provide annually to campus faculty and staff information on:
- prevention, identification and treatment of head lice
- new trends in public health and current research regarding pediculosis
- district standards and campus procedures for appropriate management of head lice, and
- laws, policy, and ethics related to confidentiality, and the right to privacy and dignity for student and their families.
Classroom presentation will be made to Kindergarten and 1st grade classes on prevention, and other grade levels at teacher/principal request (may be done in the larger context of infection control, such as handwashing, etc.)
School RNs will also maintain a section on their campus websites related to pediculosis, including prevention and management, as will the director of health services on the main health services website.
PTAnewsletters, parent meetings, and Monday folders also present opportunities for further education and awareness.
Additional Parent Resources for Head Lice
Some websites for more information on head lice:
Images to assist in the identification of head lice and their eggs
A helpful brochure in English and Spanish from the Texas Dept. of State Health Services
and from the Center for Disease Control
Other Head Lice Treatments:
Although our recommendations are outlined in the letter you received from the school nurse, we are aware that other health care providers may recommend additional treatments. Here are some of those, to help you if you choose to use them. Again, the most important thing is safely returning your child to school as quickly as possible, without the signs of active lice.
“Traditional” Pediculicide Treatments
All pesticide lice treatments must be used as directed to reduce the risk of children. Instructions must be followed carefully. The medication must not be left on the child's head for a time greater than indicated and not reapplied before package recommendations. Most treatments have different recommendations; one brand may have different instructions than another.
Traditional pesticide treatments for head lice may include those described below.
Over-the-Counter Head Lice Medications
Permethrin - Brands such as Nix or other generic store brands.
Pyrethrum - Brands such as Rid, Pronto, A-2000 or other generic store brands.
1-2-3Lice Elimination Kit - contains three products, shampoo, Egg and Lice Comb-out Gel, and a spray for non-washable items.
Both permethrin and pyrethrum should not be used on children or adults allergic to chrysanthemums, ragweed, or petroleum products.
Prescription Head Lice Medications
Malathion Lotion - Brands such as Ovide (Caution: Flammable Product)
Lindane - Brands such as Kwell
National Pediculosis Association does not recommend this product for use by children as it is potentially dangerous to the nervous system. Research finds this product to be a toxin that can cause brain damage and even death.
All pesticides used to treat head lice require careful and proper use for safe and effective treatment. Each one has specific instructions that must be followed carefully. Because all may be irritating to the eyes, mucus membranes, and scalp, it is best to use a sink for treatment to minimize body exposure. Children should never be allowed to apply or treat their own hair. Adult supervision is absolutely critical for safety and effectiveness. Rubber dishwashing gloves are recommended for use during treatment.
No pesticide or alternative treatment will be successful without effective removal of all live lice and nits (eggs) by combing and picking them from the scalp and hair shafts. If live bugs remain after treatment with one product, then a different product should be used for the next treatment after the recommended waiting period. This is a good time to use alternative treatments while waiting for the waiting period to elapse.
Pesticide sprays to the environment are generally not effective and are felt to be dangerous to children. Thorough washing and vacuuming is safer and more effective. A lint remover (the roller kind with sticky tape) can be used on the difficult areas where a vacuum cannot reach. Daily inspection and removal of any live lice and nits and treatment of the environment are crucial to preventing re-infestation.
All combs and brushes should be replaced or soaked in hot water (130o F) for at least 10 minutes.
All laundry should be washed and rinsed in hot water with a detergent. One alternative product that has been developed is Acu-Life Lice Wash Laundry Detergent which contains
Tea Tree Oil to kill lice in bedding and clothes.
Alternative Lice Treatments
Several products are on the market that are advertised as more “natural” than the the traditional treatments for preventing head lice. Some of those products are listed below.
These are most successfully used in conjunction with the more traditional pediculicides.
Alberto VO5 Shampoo
1. Cover the entire scalp with Alberto VO5 shampoo. Use as much as needed to saturate the hair.
2. Cover the scalp with saran wrap or a plastic bag or cap, and secure it to the head with a hairpin or clip. Be very careful not to cover the child's nose or mouth. Always supervise a child the entire time this covering is in place.
3. Leave this in place for 30 minutes, then rinse well.
4. Blow-dry the hair. Carefully go through hair and remove every lice and egg (nit) using your fingernails or a special lice comb.
Clear Lice Infestation Removal Kit
This product kit contains Not Nice to Lice Mousse that uses enzymes to kill the lice and also contains a fine tooth lice egg comb.
Step 1. Use an over-the-counter pediculicidal shampoo or crème rinse to kill most of the lice. Read the labels carefully and discuss the product with your doctor or pharmacist. The National Pediculosis Association discourages the use of Lindane (Kwell), a prescription product that can cause serious side effects.
Step 2. Apply olive oil treatment to smother and kill active head lice (lab tested at the Harvard School of Public Health). Apply as demonstrated in the video using the following calendar:
Olive Oil Treatment Days: 1, 5, 9, 13, 17, & 21.
The treatments have been carefully timed to coincide with the life cycle of the louse. If you choose not to use a pediculicide, use the olive oil treatment on Day 1 and Day 2 in addition to all other designated days (see below).
You may do the treatments more often if you like, but do not miss any of these days or, chances are, you will have to start over.
Step 3. Perform the housecleaning steps in the parent letter from DISD to clean the environment and help avoid re-infestation.
Step 4. Leave the olive oil in the hair and comb out the nits using a good metal nit comb. Comb the hair section by section. Then comb carefully over the entire scalp. Wash out the oil with a gentle hair shampoo.
Note: The olive oil kills by covering the holes through which the lice breathe. If lice aren't completely covered by oil, they may not die. But the oil will slow them down, allowing them to be caught in the nit comb. If the pediculicide fails to kill a bug, it means that bug is resistant and will never be killed by that chemical, no matter how many times you use it. This is not true of olive oil. Each time you use the olive oil, it has a better chance of killing each bug.
Step 5. Check dry hair in bright light for any nits you have missed.
This is a pesticide-free product. For more information or to order call
1.877.534.5435or visit their website at .
This product is a thick white water based gel composed of 10% sodium chloride (salt) that paralyzes lice. Call
1.800.482.4464for a free sample and product information.
Lice Ice is a natural, non-toxic head lice treatment that requires little to no combing. It can be used as often as re-infestation occurs or everyday as a preventative. It is applied to DRY hair, massaged to the roots, allowed to dry completely, and left on for at least 8 hours. Hair is not to be covered. Regular shampoo removes the product.
Lice Ice is non-greasy and pleasant smelling. Because Lice Ice is based in a hair styling product, it does not dry out the hair. It can also be used on scabies. It is found in some Walgreen Drugs.
This is a product of essential oils that is added to water and sprayed onto the infested scalp. This all-natural product is reported to immediately kill head lice.
This product is a water-based gel that paralyzes lice and saturates the hair shaft to help nits readily slide off. It is registered by the FDA as a medical device accompanied by a comb and an optivisor to assist visibility. For more information or to order call Wal-Med, Inc., at
1.877.542.3688or visit their website at .
Thursa Herbal Inc. Head Lice Shampoo
This is a chemical free product that contains 5 herbs, vegetable shampoo, cider vinegar, and castile soap. This product is supposed to cause nits to fall out during rinsing and stuns active lice making them easier to be removed.
For many good reasons (see the information sheet below), we require that children who have evidence of head lice stay home from school until the condition is gone. This usually takes only one day, two at the most, although you will need to continue to follow the directions below for the next two weeks. After the first day or two, though, it is as simple as combing your child’s hair each day, and doing a little extra vacuuming.
For the first two weeks:
Day 1 when you pick up your child at school, come in to visit, and I’ll show you where the lice/nits are. Some parents have never seen them, and I’ll be happy to show you how to look. It’s an important task for you to do on a regular basis.
1. Get a “Licemeister” or other long, metal lice comb (the plastic ones do not work as well) from Walmart or CVS or Walgreens – they cost about $10. If you can’t do that, ask me if you may borrow one from the school. We keep a couple on hand, and of course, they are cleaned thoroughly in between uses.
2. Wet your child’s hair, divide it into small sections with clippies or hairpins, and in the bathtub or outside, comb through each section of hair with the lice comb thoroughly. You’ll need to clean the comb at intervals, too, because the lice and nits will get caught in the comb. Dental floss, or strong thread will work to clean out the comb, and it comes with directions for cleaning after each use as well.
3. Gather up the bed linens from the beds and wash them in hot laundry water, and dry them on the hottest dryer cycle, or take them outside to hang dry in the sun. Take any stuffed animals, throw rugs or bed items that cannot be washed and put them in a plastic bag for the week.
4. Vacuum any carpets and cloth furniture, including the car seats.
5. Rest…you’ve done a lot today!
Day 2 Repeat steps 2 and 4 above, and finish anything else that you didn’t get done on day one. Hang in there, it gets easier!
Days 3-7 Just do the combing and vacuuming each day. You can take the bagged items out of the bags now. Do the laundry again.
Days 8-14 Just do the combing each day, preferably in the morning before school.
Days 1 and 2 should have taken care of biggest concerns and your child needs to be back in school by day 3 at the latest. We want him or her to return as quickly as possible. BE SURE to stop by my office on the way in so I can check your child with you there…that good communication between us helps tremendously. I am here to give the best possible health care for your child and all the other children in school. You should always discuss all the treatment options with your health care provider and make the decision you think is best for your child, and again, you can reach me by phone or in person during school time.
Some things we encourage you NOT TO DO to get rid of the lice:
We DO NOT advocate using the pesticide shampoos on the market such as Rid, Nix, and all those others out there, even if they say “non-toxic” or “natural.” There is strong evidence that they are not as effective as they once might have been, and it is still putting pesticides (something that kills bugs) on your child’s head, close to their eyes, ears, nose, and mouth. And never put anything dangerous like kerosene or gasoline or bug spray or pet shampoos for insects on your child’s head.
Another thing we DO NOT encourage is the use of lice or other bug sprays for the house, car, furniture, etc. Houses and cars don’t get head lice…people do. Those sprays are costly and not very effective during most of the stages of growth of the insects… it’s a waste of your time and money, and does not produce the desired results!Please call me if you have any questions; working together we can get your child back into class quickly and lice-free.Lesa Mash, RN, BSN940-369-4551