A Healthy Standard for
Children and their Families
The National Pediculosis Association, recommends the
No Nit Policy as the public health standard intended to keep children lice free,
nit free, and in school.
Pediculosis represents one of the most
common communicable childhood diseases and whether or not we understand how this
has evolved, it is important to acknowledge head lice as a problem when raising
or caring for children.
The Spirit of the
No Nit Policy is to minimize head lice infestations as a public health problem
and to keep children in school lice and nit free.
Establishing Consistent Guidelines
The No Nit Policy encourages each family to do
its part at home with routine screening, early detection, accurate
identification and thorough removal of lice and nits. Establishing consistent
guidelines and educating the public about procedures in advance of outbreaks
helps minimize inappropriate responses.
Early intervention provides the needed
assurance for those who have successfully eliminated an infestation that
everything possible is being done to prevent new outbreaks when children return
to groups where close contact is inevitable. Repeated exposures to pesticidal
products put children at risk. Parents need to be informed
that chemical treatments may also be dangerous for children with certain
pre-existing medical conditions and/or medication regimens. Families with
pregnant or nursing mothers should be given advance notice that early detection
with manual removal of lice and nits can serve as a safe alternative to
pesticidal lice treatment products.
Why The Controversy?
Opponents of No Nit Policies say that
"overzealous" enforcement can lead to inappropriate exclusion of
children with residual nits, but whose infestation has otherwise been
"treated." Those who judge enforcement to be "overzealous"
may not consider the broader public health values and preferences of the
community. Few who oppose the No Nit Policies would accept infestations for
themselves or for their own children.
Without the No Nit Policy, communities are left with a
hit-or-miss approach. Indifference about adopting a standardized management
protocol permeates the attitudes of health professionals at every level. This in
turn gives way to a maze of conflicting opinions and directives that are
counterproductive. Public health policies for head lice cannot be based solely
on the use of chemical remedies.
The Food and Drug Administration recommends repeating
chemical treatments in 7-10 days because none of the available treatment
products are 100% effective against lice eggs and that remaining viable nits
will hatch lice. Unfortunately, the FDAs directive does not take into
consideration the endemic nature of head lice. Children being managed in this
manner can infest others or become reinfested in the interim. Mechanical removal
of head lice and nits is less noxious and more likely to be successful than
repeated chemical treatments.
Will Make The No Nit Policy Succeed
Community Education:The community is
given a baseline understanding of the louse, modes of transmission and the
importance of safe and effective control measures. Information-sharing targets
everyone in the circle of responsibility for children -- from parents, siblings,
friends and neighbors to school nurses, teachers and principals, to pharmacists,
physicians, product manufacturers and government agencies.
Screening and Early Detection:Vigilant screening of children
for head lice and nits plays a pivotal role in pediculosis management. Early
detection offers the best opportunity to manually remove head lice and nits
without pesticide exposure. This directive is
consistent with traditional preventive medical and communicable disease control
Removal of All Lice and Nits:There are no safe pesticides,
"natural" or otherwise, scientifically proven to be 100% effective
against head lice, nits or nit glue. Reliance on head lice treatment products
that are ineffective promotes repeated use of potentially harmful chemicals and
contributes to ongoing infestations, outbreaks, and resistant strains of head
Parents should be discouraged from spending unnecessary
time and money on "concoctions" for which there is no scientific basis
for claims or evidence of efficacy and human safety. A wide variety of such
"lice remedies" are vigorously marketed to consumers especially via
the Internet. The result is more confusion for families already deluged with
conflicting treatment recommendations. Manual removal is the safe
alternative and necessary component to any head lice treatment regimen.
TemporaryDismissal of Children with Head Lice and/or Nits:Administrators and health personnel must take all reasonable measures
to help ensure that infested children do not join the group setting. It is more
than fair to expect that uninfested children will be safeguarded while infested
children will be cared for with sensitivity. Monitoring with enforcement through
scheduled and announced group screenings encourages parental compliance and
promotes community cooperation and individual accountability. This does not mean
panicked emergency pick-ups. The goal is to avert a crisis mentality by enabling
families to keep their children lice and nit free.
There are practical approaches that include readmitting
children whose parents have done an excellent job of nit removal but may have
missed a single nit. This nit should be removed immediately, a
step that both supports the No Nit Policy and allows the child to return to
Promptly inform all parents of a case of head lice.
Here is a sample letter to parents:
"A case of head lice has been reported in your
childs group. Head lice continue to be one of the most prevalent communicable
childhood diseases among children, and outbreaks are possible whenever and
wherever children gather. Screen your child regularly and notify us immediately
if head lice or their nits (lice eggs) are detected. (We welcome the opportunity
to teach those of you who do not know how to check your child for head lice).
Working together helps protect all of the children, including your own. Thank
you for your cooperation."
Head Lice Aren't All Bad News
Head lice provide an early opportunity to teach
children responsible personal health behaviors. Children can learn communicable
disease prevention concepts in a meaningful way and learn to take responsibility
for their actions. It is vital that we build consistent and positive public
health messages for children who mature into a world of behavior-related health
threats including alcohol, drugs and AIDS.
Administrative Advantages of
the No Nit Policy
Having the No Nit Policy in place makes the task of the
staff of the school, camp, or child care facility more realistic and less
subjective. If nits are present upon screening or re-screening, the child is
dismissed for follow-up. As an administrative policy, it helps parents
understand and assume their responsibility for head lice control. Families are encouraged to respond
by carrying out the most effective prevention measures at all times and the
safest most thorough control measures possible. For the child whose family
is unable, for whatever reason, to comply with the policy, the “system” must go
the extra mile to ensure the child is able to return to their group lice and nit
free. The reward is an environment of mutual
assurance that the child enters a group setting that supports a head lice
Medical and Social Advantages
of the No Nit Policy
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
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 class time for the majority
of the children and prevents lost days at work that can be costly for
non-removal of nits as one of the primary causes of treatment failure. With nit
removal absent from school policy, children with hatching nits are readmitted to
the group setting. Still there are many, perhaps more distant from the front
lines, who dispute the value of removing nits. This opposition is based on a
reliance on chemical agents rather than a preventive approach, a belief in
second and even third pesticide treatments as "mop-up"
operations and the notion that pediculosis is not a significant disease.
In 1990, the NPA published a warning to the public that
resistant strains of head lice were inevitable based on the way the products
were being vigorously marketed and inappropriately used. Again in 1995, the NPA
notified leading manufacturers of both permethrin and pyrethrin-based
pediculicides that the NPA was receiving increased numbers of treatment failure
reports from parents and health professionals alike, indicating possible lice
resistance to some of these products.
In 1996, the NPA sponsored independent scientific
evaluations of head lice sensitivity which documented permethrin-resistant head
lice from children in Massachusetts, Iowa, and Washington. In 1997, the World
Health Organization review of treatments for pediculosis noted the issue of lice
resistance to almost all of the commercially available pesticide treatments
including permethrin-based products. As recently as February 1999, the Journal
of Parasitology reported lice resistance in England, following in the footsteps
of journal reports from Israel, Czechoslovakia, France and the U.S. Resistance
issues alone warrant that people be reminded in advance that products may not
provide the positive outcome they seek. Repeated use of these products will not
change product performance and may risk children's health and contribute to more
strains of resistant lice.
absence from school or child care is a loss of educational opportunity and an
encumbrance to working parents, readmitting an infested child is not the
solution. A policy for head lice must consider not only the infested child, but
also his or her peers who have already been successfully deloused or who have
not yet been infested. All this considered, the No Nit Policy remains a sensible
approach that sets the standard to serve and protect all the children in the
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