HeadLice.Org Hot Spots

The American Academy of Pediatrics (AAP)
Issues Guidelines Allowing Children
in School with Lice and Nits


There is little that is new in the August 29th, 2002 news release issued by the American Academy of Pediatrics as guidelines for clinicians dealing with head lice.

The guidelines do little to eliminate the confusion and misinformation that has always been the hallmark of pediculosis management. In the absence of a nationally standardized approach, head lice remain a controversial issue with differences between industry driven guidelines for treatment and consumer needs and wants for safer and more effective choices.  While school absence is a problem, readmitting an infested child is no solution.

The National Pediculosis Association® (NPA) works to minimize the politics of lice by focusing on what is most helpful in a practical sense to parents and least disruptive to family and school life. Just like brushing one’s teeth, the NPA recommends routine screening as a step in basic hygiene, with early detection of lice and nits and thorough manual removal. This allows parents to avoid panic, more challenging long-term infestations, and the use of a variety of potentially toxic chemical treatments such as those that contain lindane and malathion. The NPA’s goal is to protect children from the misuse and abuse of pesticidal treatments and to keep children in school lice and nit free and ready to learn.

The AAP guidelines are consistent with the organization’s longstanding opposition to a No Nit Policy. AAP advocates keeping children in school with lice and nits. The NPA has a recommended No Nit Policy establishing a public health standard that puts education and prevention in advance of outbreaks. And while this may be the common goal for all No Nit Policies, it should be clarified that all Policies are not the same. Schools and nursing personnel must tailor their management policies to their resources and particular situations. Just this week, we were contacted for help by a school nurse in Utah who was one of only 3 school nurses responsible for children in 36 schools. These school nurses, along with thousands of others like them, rely heavily on the participation and cooperation of parents.

The AAP guidelines surprisingly give little if any credit to the school nurses and their ability to accurately screen for head lice and limit infestations. This is unfortunate, since thanks to school and public health nurses, thousands of communities are doing an excellent job controlling head lice without the use of pesticidal products. This can be documented by the continuing decline of pediculicide product sales.

Some of the key information in the AAP clinical report is regrettably out of date. For example, the AAP states that lindane “ should be used very cautiously,” however new labeling will prohibit its use for children. Malathion has no safety studies available on children under the age of 6, yet the report states; “it can be used with extreme caution in the treatment of only those cases in which resistance to other products is strongly suspected.” The most obvious concern about this directive is that pesticides accumulate in the body; lice products are not intended nor approved by the FDA to be used repeatedly, in conjunction with, or as a follow-up to other chemical formulations. Thankfully, the AAP report does advise against the use of lice sprays for bedding and the environment, which is a commonly ignored additional and unnecessary chemical exposure.

AAP is far too casual about resistance issues as this is a major factor in overuse and over-exposure to pesticidal treatments. Resistance and cross resistance to the most popular remedies including permethrin is well established, as reported at the Congress on Lice held this July in Australia and reiterated at the American Chemical Society’s annual meeting in Boston last week. However the AAP states; “the prevalence of this (permethrin) resistance is not known.”

Nor does the AAP address the growing number of children and families for whom a non-chemical approach to controlling head lice is critical. Treatment decisions must be based on the unique vulnerabilities of each person. Pesticide treatments or chemical agents of any kind are contraindicated for a variety of individuals including but not limited to infants, young children, and the growing number of those with chronic illness, having chemotherapy, using medications, or simply already overexposed to pediculicides. Treating for head lice puts both the person applying the treatment, as well as the person receiving treatment at risk. This is especially important for pregnant or nursing mothers.

School nurses, public health nurses and school principals who have found success with their No Nit Policies will continue to enforce them regardless of AAP guidelines …just as the NPA will continue to encourage communities to be proactive about screening, early detection, and manual removal to prevent the use of pesticides on children. As our motto states, “Because it’s not about lice, it’s about kids.”


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