are urged to ease tough lice policy
Posted on Tue, Sep. 03, 2002
Inquirer Staff Writer
Saying that no healthy child should be barred from school, the
American Academy of Pediatrics is recommending that schools back off
tough head-lice policies.
Many schools have "no nit" policies, which say that every single
nit - or head louse egg - must be removed before a child can return
"The presence of nits, per se, doesn't indicate active
infection," said Leonard Weiner, a pediatrics professor at the State
University of New York in Syracuse and one of the authors of the
report published today in the journal Pediatrics.
The "no nit" policy isn't sensible because nits are only
nuisances when they are viable, or less than one-quarter of an inch
away from the scalp, said Weiner. Normally, nits further away cannot
become full-grown lice.
"People see dead nits or empty egg cases, which are then
mistakenly assumed to be an infection," he said.
"Numerous anecdotal reports exist of children missing weeks of
school and even being forced to repeat a grade because of head
lice," wrote the authors.
Head lice, which don't spread any disease, each year affect about
6 to 12 million children, ages 3 to 12. The report also said school
staff involved in head-lice detection should be properly trained.
Currently, school screening for nits is neither accurate nor cost
effective, it said.
The authors say parent education programs would be more
appropriate than school screening programs for head lice.
The authors suggest parents treat lice with permethrin 1 percent,
commercially known as Nix. At the time of treatment, parents should
consider removing as many nits as possible, whether they are viable
or not, to decrease diagnostic confusion and the possibility of
School nurses and other trained personnel could help by
rechecking a child's head for lice, if requested, said the
In addition, on the day of diagnosis, school officials should be
practical when determining how contagious a child could be; a child
with "hundreds versus a child with two live lice" are different,
wrote the authors.
Some Philadelphia-area school officials agreed with the
"They appear to me to be sound recommendations," said James
Newcomer, the assistant superintendent for pupil services/elementary
education at the Quakertown Community School District in Bucks
The guidelines are consistent with the way the Quakertown
schools, which do not have a "no nit" policy, approach the problem
of head lice, he added.
"Even after treatment, there may be some nits that remain in the
hair which are no longer viable," he said. "That can cause
confusion. We encourage parents to brush nits out of the hair."
"We don't want children to miss school," said Newcomer.
Deborah Altschuler, president of the National Pediculosis
Association, an organization that looks at education, prevention,
and research regarding head lice, was critical of the new
guidelines, saying they missed the point.
The organization supports a "no nit" policy, but such policies
are not keeping children out of school, she said. Rather,
ineffective treatments are the reason.
"Resistance and cross resistance to the most popular remedies
including permethrin are well established," said Altschuler in a
"Pesticide treatments or chemical agents of any kind are
contraindicated for a variety of individuals. Treating for head lice
is unique among health problems as it puts both the person applying
the treatment, as well as the person receiving treatment at risk,"
The American Academy of Pediatrics, however, said that while
resistance to permethrin 1 percent and other lice treatments has
been reported, the extent of drug failure is not known.
It is a misconception that lice jump. They crawl, and their
spread is usually through shared combs, brushes, hats or through
carpets where an infected child may have been lying.
Contact Aparna Surendran at 215-854-2795 or