Child Care Provider's Guide To
Controlling Head Lice

Pre-school 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 chemical treatments.

Head lice 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 occur.

Effective 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.

By providing accurate information, you can minimize the need for crisis intervention, the use of pesticides on children and unnecessary disruption to the child care experience.

Establish a Head Lice Control Standard

·         Communicate your 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.

·         Announce regularly scheduled screening dates and send reminders the day before.

Notify parents in advance of any additional screening whenever possible.

·         Reinforce your 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 combed anyway. 

Teach Screening Procedures

·         Group 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). 

·         Although nits 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 hair.

·         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.

·         Two people 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.

Parent Notification

·         Promptly inform 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.

•  Anyone on medication or who has a pre-existing medical condition
  such as allergies, asthma, epilepsy, cancer.

•  Children under two years of age.

•  Children who 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.

·         Advise against treating anybody who is not infested and the use of repellents.

·         Strongly 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.

·         Malathion is 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.

·         Additionally, both Lindane and Malathion are environmentally unfriendly and pollute the water supply when they are rinsed off.

·         Over-the-counter head lice treatments are also pesticides and there are NO safe pesticides.

·         Inform parents that none of the products are 100% effective.

·         Based on 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.

·         It is 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 only.

Inspect Your Facility

·         Coats and hats should be hung separately and spaced so they do not touch. Lice do not hop, jump or fly.

• Hats should be tucked into coat sleeves.
• Coats should not be piled or stacked.

·         Children should not share clothing or headgear.

·         Review your 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 vacuumed regularly.

·         Carpeted areas 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.

Temporary Dismissal

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 screen themselves.

·         Notify all 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.

·         Reassure parents 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

·         Review procedures with staff and consider steps that many not have been regularly adhered to - separating sleeping mats, coats and hats.

·         Remind children of the importance of not sharing headgear or personal articles.

·         Remind parents 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. 

·         Encourage the children and help them feel comfortable about speaking up if they feel itchy.

Administrative Advantages of the No Nit Standard

Having the 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

·         Prevents continuing infestations caused by the surviving and hatching of nits.

·         Maximizes the opportunity to eliminate repeated chemical treatments aimed at killing head lice that hatch from remaining viable nits.

·         Eliminates confusion – Were these eggs here before or do they represent a new infestation?

·         Contributes to improved standards of personal hygiene and self-esteem, protecting children from ridicule and rejection.

·         Enhances uninterrupted group time for the majority of the children and prevents lost days at work that can be costly for parents.

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