No-nit policies subject of debate

Another school year begins and so do questions about head lice and school policies for children with nits.

by Tara Grassia
Staff Writer

September 2004

While “no-nit” policies are discouraged by some experts, others recommend them as a public health standard intended to keep children lice-free, nit-free and in school.

“Without the no-nit policy, communities are left with a hit-or-miss approach,” the National Pediculosis Association (NPA)’s policy states. “Indifference about adopting a standardized management protocol permeates the attitudes of health professionals at every level.”

Those groups that discourage no-nit policies, such as the AAP and the National Association of School Nurses (NASN), say that more can be done in schools to prevent a child from missing what could be weeks of school.

“As a pediatrician who cares for children in both senses of the word, for their health care and about them, I cannot agree with a no-nits policy,” said Barbara Frankowski, MD, chair of the AAP Committee on School Health. “To have a child miss school because of nits that don’t cause any harm to anyone just doesn’t make sense.”

For and against

Head lice infestation, or pediculosis capitis, tends to occur mostly among children 3 to 12 years of age, according to the AAP. Approximately 6 to 12 million cases occur among U.S. schoolchildren annually.

Some schools have instituted no-nit policies, which mandate that all students with nits or head lice be sent home from school until the nits or lice are removed from the hair. The presence of nits or lice is used as a marker for infestation, and some schools even require documentation of treatment before students can return to school.

“Part of the no-nit policy reinforces the wrong message that the schools are infested with the lice and that is the problem, when that is not really where the focus of attention should be,” Frankowski told Infectious Diseases in Children.

Absence from school means a loss in educational opportunity for the student; however, the NPA believes readmitting an infested child is not the solution.

“Education in advance of outbreaks, early detection and information on the safe and effective alternative of screening will equip families to effectively deal with head lice when they occur,” said Deborah Z. Altschuler, president of the NPA.

While the AAP recommends manual removal of lice, nit comb use and permethrin 1% as first-line therapy, resistance and possible adverse effects have the NPA questioning this recommendation.

Altschuler told Infectious Diseases in Children that chronic absenteeism for head lice is more “a reflection of reliance on ineffective treatments and the lack of a sound prevention protocol.”

Frankowski suggested that proper use of a product such as permethrin, even if not 100% effective, will decrease the live lice load and help parents be more successful in picking out the lice and nits. Resistance and adverse effects may be due to failure to follow directions; therefore, it is important physicians review the treatment process with patients, she added.

Health consequences?

Frankowski said that today there are no health issues regarding head lice besides itchiness and, rarely, superficial skin infection and skin breakdown caused by irritating products and excessive scratching.

Frankowski believes part of the problem with no-nit policies is that they are often created without scientific evidence to back them up.

“I always point out a child can go to school with a cold and no one complains, yet the consequences of a cold are far worse than that of head lice,” she said. “It doesn’t make sense; if you are going to have a no-nits policy, you might as well have a ‘no runny nose’ policy, and it would be just as ridiculous to try to do that.”

Despite differing opinions regarding no-nit policies, the AAP, NASN and NPA agree that early detection plus teaching about prevention and treatment can minimize head lice infestations among children.