children and their parents face many new challenges as they begin their first
experience in a group setting. One of these challenges is the risk of children
contracting head lice and the use of ineffective and potentially harmful
are a common occurrence among young children who are most vulnerable to the
dangers associated with the misuse and abuse of head lice treatments – the
majority of which are pesticides. For this reason, child care providers should
establish a proactive head lice management protocol before outbreaks
head lice control is based on a high standard of education, prevention and
accountability for both parents and staff. Conflict arises when there is no
standard in place.
accurate information, you can minimize the need for crisis intervention, the
use of pesticides on children and unnecessary disruption to the child care
Establish a Head Lice
policy to your staff and teach them how to properly identify head lice and nits
(lice eggs). The NPA’s Critter Card presents a clear and realistic depiction
of both lice and nits.
Staff members should understand the rationale behind your head lice standard.
Staff should be prepared to respond to child and parent questions.
Because dismissal can be awkward, be sure parents are aware of your policy on
when a child will be dismissed and the conditions for their return.
As part of your
health registration guidelines, provide parents with your written policy and
educational literature on prevention, detection and treatment of head lice.
Parents should understand the importance of screening often, detecting head
lice and nits as early as possible and removing them safely and effectively.
They should also understand the risks of using pesticidal lice products and be
informed of non-chemical treatment alternatives.
regularly scheduled screening dates and send reminders the day before.
Notify parents in advance of any additional screening whenever possible.
efforts by encouraging parents to make lice inspection part of the child’s
personal hygiene care at home. Screenings are most easily done as part of the
child’s normal routine – after bathing or showering when their hair would be
inspections should be done with disposable screening sticks. Look for nits –
tiny yellowish-white oval eggs firmly attached at an angle to the hair shaft.
(The Critter Card is a useful tool.) Contrary to some claims, nits found more
than a quarter inch from the scalp are not necessarily dead. Viable nits can
be found anywhere on the hair. The diagnosis is made more often by seeing the
attached nits than by finding crawling lice.
Be sure not to
confuse nits with hair debris such as DEC plugs (bright white
irregularly-shaped clumps of dandruff stuck to the hair shaft), or hair casts
(elongated segments of dandruff encircling the hair shaft).
may be more prevalent at the nape of the neck, around the ears and at the crown
of the head, check the entire scalp since nits can be found anywhere in the
Nits are tiny
and can be difficult to remove. They are firmly attached to the hair shaft and
cannot be brushed out or removed with a regular comb.
Lice are about
the size of a sesame seed, clear in color when first hatched and then become
brown after they feed, and move quickly away from light.
checking through a child’s hair at the same time can be helpful.
If it is
questionable if a child has nits, the LiceMeister® Comb can be used
as a diagnostic tool.
all parents when a case of head lice is detected.
Alert parents to
the risks of using pesticides.
Those especially at risk include:
Women who are
pregnant or nursing.
medication or who has a pre-existing medical condition
such as allergies, asthma, epilepsy, cancer.
two years of age.
have been repeatedly exposed to chemical treatments.
Head lice treatment can be harmful both to the person
applying the treatment and the person being treated. This is why the NPA
encourages a non-chemical approach with manual removal whenever possible.
treating anybody who is not infested and the use of repellents.
discourage the use of products containing lindane. Lindane is a prescription
lice product and a known neurotoxin and has been associated with adverse
reactions ranging from dermatitis to seizures to death.
another pesticide prescription product that should be avoided. Unfortunately,
it is often recommended when the child has already been exposed to other
pesticide treatments that have failed.
both Lindane and Malathion are environmentally unfriendly and pollute the water
supply when they are rinsed off.
head lice treatments are also pesticides and there are NO safe pesticides.
that none of the products are 100% effective.
scientific reports of lice resistance on a national level, the NPA advises
parents to discontinue the use of lice products at the earliest sign of
treatment failure. MANUAL REMOVAL IS THE BEST OPTION WHENEVER POSSIBLE AND
ESPECIALLY WHEN TREATMENT PRODUCTS HAVE FAILED.
Warn against the
use of lice sprays. Recommend vacuuming as the safest and most effective
alternative to spraying. Using lice sprays on bedding, furniture and carpets
is unwarranted and poses both personal and environmental risks.
unnecessary to bag objects that can’t be washed such as stuffed animals.
Vacuum them instead. Parents should save their time and energy for what will
benefit them the most: thorough nit removal.
Head lice cannot
be gotten from–or given to–animals. They are “host-specific” and infest humans
Inspect Your Facility
Coats and hats
should be hung separately and spaced so they do not touch. Lice do not hop,
jump or fly.
should be tucked into coat sleeves.
should not be piled or stacked.
not share clothing or headgear.
policy on dress-up corners. Dress-up is a valuable play activity, but it can
also be risky for head lice outbreaks. We recommend discontinuing shared
dress-up clothing and replacing it with disposable articles if possible.
Sleeping mats or
towels brought from home should be individually labeled and stored in separate
cubbies or in a duffle-type bag. Ideally, such items should be laundered or
should be vacuumed as often as possible.
NEVER use pest extermination services for
head lice: buildings don’t get head lice - people do. Vacuum only.
When a case
of head lice is found:
Infested children should be prepared for pick-up with a minimum of
fuss. When the parent arrives, he/she should be given another copy of the Dear
Parent Letter and your guidelines explaining that the child may return as soon
as she or he is free of lice and nits. It is helpful to have effective lice
combs on hand to ensure the child is treated safely and successfully and able
to return as quickly as possible. The comb can also be used for parents to
parents that lice have been found within the group and arrange for the entire
group to be screened as soon as possible. Screenings can be conducted close to
dismissal time in order to minimize disruption. Remind parents to check all
their children carefully each day for the next few weeks and to continue
checking as part of their routine hygiene.
Be prepared to
answer questions. Parents may feel overwhelmed and need to review the
information from your health packet.
that head lice do not necessarily reflect unsanitary households or neglected
children. Learning that your child is being dismissed due to a head lice
infestation can be distressing.
Use a quality
lice removal comb to examine children returning after an infestation to confirm
successful resolution before the child re-enters the group. The comb will
detect even what could be missed during visual inspection to ensure the child
is lice and nit free.
Prevent New Outbreaks
procedures with staff and consider steps that many not have been regularly
adhered to - separating sleeping mats, coats and hats.
of the importance of not sharing headgear or personal articles.
of the importance of screening often, detecting head lice and nits as early as
possible, removing them safely and effectively and continuing to screen as part
of their routine hygiene.
children and help them feel comfortable about speaking up if they feel itchy.
Advantages of the No Nit Standard
No Nit standard in place makes head lice management more realistic and less
subjective. As an administrative policy, it helps parents understand and
assume their responsibility for head lice control. Families are encouraged and
enabled to respond by carrying out the most effective prevention measures at
all times and the safest most thorough control measures possible. The reward is
an environment of mutual assurance that the child enters a group setting that
supports a head lice control program.
Medical and Social
Advantages of the No Nit Standard
continuing infestations caused by the surviving and hatching of nits.
opportunity to eliminate repeated chemical treatments aimed at killing head
lice that hatch from remaining viable nits.
confusion – Were these eggs here before or do they represent a new infestation?
improved standards of personal hygiene and self-esteem, protecting children
from ridicule and rejection.
uninterrupted group time for the majority of the children and prevents lost
days at work that can be costly for parents.