Part Two -
My first article in a
series of writings resulted from researching the treatment of head lice
in both the preschool as well as the regular school settings. What I
found was information that was often confusing, and at times made me
angry since it appeared it was written for the benefit of the drug
companies and not the children. (See previous article.)
There are interesting aspects of the Contemporary Pediatrics Supplement
of August 2000 “Guidelines for the Treatment of Resistant Pediculosis”
in addition to those I addressed earlier. For example, why do the
Guidelines discourage screening, a tried, tested and rational approach
to protecting children’s health?
In the Guidelines, the panel of experts stated that “mass screenings are
disruptive and not warranted.” What these experts overlooked is the fact
that health screening for both preschool and elementary students are
held during the school day for many different reasons. Physical
education and health teachers and school nurses frequently conduct
height and weight screenings throughout the school year: hearing,
vision, and dental examinations are also performed during school hours.
The students and school personnel (nurses and teachers) are accustomed
to taking part in mass screenings.
A classroom or school-wide screening is the most economical and
effective way to both find cases of head lice as well as teach parents
and students about this age old health problem in a positive way. As
stated earlier, screenings are in no way new or disruptive in the school
environment. This type of head lice screening requires no expensive
equipment; the examination is totally non-invasive as well as painless.
What is required is planning and preparation on the part of school
administrators, the school nurse, teaching staff and families. Screening
must be scheduled in advance, parents notified and adapted to
accommodate the varied resources available in different schools.
Although the preferred approach would be to utilize only medical
professionals, reality dictates that, since many districts don’t even
have a school nurse assigned to each school, other resources must be
utilized for this process. Sensitivity to the child’s feelings, the
issue of confidentiality and accurate diagnosis must be at the forefront
of any screening program.
According to the Guidelines, Hansen and colleagues stated, “Positive
diagnosis is essential to avoid indiscriminate use of therapies, which
can lead to resistance.” Is Hansen once again suggesting that lice can
develop resistance if you treat a child who doesn’t have them?
Regardless, Hansen is indeed partly correct. No healthcare provider
wants to subject a patient to indiscriminate use of therapy or
As screening programs must be adapted to the school and resources, No
Nit Policies (although discounted in the Guidelines) form the basis for
responsible head lice management. The National Pediculosis Association
claims that its No Nit Policy sets the standard for promoting screening,
early detection and manual removal – keeping children in school lice and
nit free and ready to learn. The policy states: “Early detection offers
the best opportunity to manually remove head lice and nits without
pesticide exposure and unnecessary absenteeism. This directive is
consistent with traditional preventive medical and communicable disease
Each year brings new health issues, risks and challenges to the School
Nurse. My experience has been that any opportunity to be proactive (such
as with a screening program) benefits everyone concerned – especially
the kids – as opposed to the alternative which is to try to manage head
lice with crisis intervention.
Smithkey III, RN, BSN
Certified School Nurse,
State of Ohio
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Part One - As I moved along in my studies and
research in my chosen field of a school nurse, I became increasingly
interested in the area of treatment of head lice among school and
preschool children. I realized that most childhood illnesses had a
set course of prescribed treatments one would assume was based on
scientific and medical evidence. I discovered this was not
necessarily the case with head lice and came upon an example that blew
me away. No doubt some treatment recommendations are based on
science, but check this out.
They call it the "Guidelines for
Resistant Lice" from an expert panel that met at the Harvard School of
Public Health and was funded by the makers of the malathion product
known as Ovide. The consensus of their meeting was published as a
supplement in Contemporary Pediatrics. I could find no sign of
independent peer review. These are the same Guidelines that
supposedly reversed all that was known about managing head lice and are
commonly referred to by others setting new policy on head lice including
the American Academy of Pediatrics.
The expert panel was mainly
individuals who worked for the makers of lice treatment products.
Even overlooking their apparent bias, the kicker was their list of
factors that cause head lice to become resistant to drug therapy.
The authors listed and highlighted them in the
publication. Their list of factors is not only inaccurate, it is
|Factors contributing to
- Inappropriate use of
pediculicides in non-lice cases (dandruff, pseudonits).
- How can a louse become resistant when
there are no lice in the patient's hair? If there are no
lice, resistance cannot occur!
- Overuse of
over-the-counter treatments on nonviable nits or dead lice.
- Resistance cannot develop when a
product is applied to dead organisms, whether it is overused
- Misuse of pediculicides
(not following product instructions).
- Use as prophlaxis.
- How do you create resistance when you
use a treatment as a preventive before you even have lice or
I am baffled. Did
anybody proof this document? Better yet, did anybody read it?
How did the professional organization that represents school nurses
approve this report?
Needless to say, I was
stunned as I read this set of Guidelines. Because of the confusion
they have created, I have decided to present a series of
articles on HeadLice.Org that I hope will cast some light on a very
Smithkey III, RN, BSN
Certified School Nurse,
State of Ohio
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