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In the battle to stop the spread of head lice among students, nurses practice a nit-picky no-nit policy
Reprint from The The Grand Rapids Press, 3/17/2009.

March 17, 2009

Each week, to keep the little bugs from crawling all over the campus, Marilyn Hebert checks for lice in the hair of Fennville elementary school students. Some may call the preventive measure nitpicky, but that's exactly the point.

"It's just a routine that we've carried on, and we've found that it's effective," said Hebert, a Fennville school nurse for the past 19 years. "By checking a quarter or a third of the class every week, we can catch it."

Students found to have a louse, or even lice eggs called nits, are sent home. Hebert welcomes them back only when the wingless insects and their unborn fly babies have disappeared.

The school's no-nit policy is contrary to state and national standards that discourage the practice as overly penal. The Michigan Association of School Nurses also recommends against a no-nit policy, one that prevents students from returning to school until their heads are clear of nits.

But Hebert, the organization's 2009 Nurse of the Year, would have it no other way.

"In order to come back into the classroom, they have to come through me first," Hebert said. "All you need to do is miss one egg, and it starts all over. There is no product out there that kills the eggs. I've seen that these pesticides are hardly even killing the live ones. You have to remove them with a comb or by nit picking."

Following the lead of the American Academy of Pediatrics, Michigan's education and community health departments in 2004 adopted a head lice manual that deems no-nit policies unnecessary. Not only does a no-nit policy embarrass students, but it also can cause them to miss excessive amounts of school when no serious health risk is present.

Controversial data

But Spectrum Health research suggests state and national agencies are wrong: No-nit policies do have a positive effect.

"We've got data that refutes their position statements," said Stephanie Painter, director of school health programs for Spectrum.

"It's controversial, and people need to hear it.

"The results of our study reveal that the no-nit policy, coupled with nursing interventions, makes a significant difference."

Spectrum provides nurses to five school districts, including Cedar Springs, Comstock Park, Godfrey Lee, Grand Rapids and Greenville.

Nurses each fall and spring screen about 4,000 students for head lice.


The lowdown on lice

Here's what you need to know:

What are head lice? Wingless insects about the size of a sesame seed that use claws to cling onto hair and suck blood from the scalp. They can't jump, run or fly, said Marilyn Hebert, Fennville school nurse. "They have kind of like claws. I always tell the kids they swing in your hair like Tarzan."

What is a nit? A louse egg attached to hair with an adhesive substance resistant to chemical removal.

The danger? Lice are not known to transmit disease. Health threats are skin irritation, bacteria infections from scratching and psychological trauma. It would be comparable to if your dog had fleas, said Linda Rothenthaler, Rockford school nurse. "It makes them itch, and, sometimes, they can get a little infection from scratching."

Are lice contagious? Generally, lice are transmitted through direct hair-to-hair contact, or from shared hats, combs and pillows. They do not crawl from one student to another.

How can they be removed? Shampoos with lice-killing chemicals can do it. So can shaving the head. Coating the hair with certain oils might suffocate the bugs. Special combs can help remove nits.

SOURCE: Michigan Head Lice Manual, Press research

Declining rates

Prevalence rates, the number of families with chronic lice problems and the number of school days missed due to lice have declined, Painter said.

She hopes the statistics get published this year in a professional medical journal.

"The data just is so significant," Painter said. "If you can just get rid of the nits, you're so much farther ahead in getting rid of the problem. That's where lice come from.

"If it's not there, you don't have to worry about it. It's not like 'Are (the eggs) alive, or are they dead?'"

Varying viewpoints

Spectrum's research butts heads with viewpoints of agencies, such as the U.S. Centers for Disease Control, which not only opposes no-nit policies but also states students diagnosed with live head lice need not be sent home early from school. Beyond that, the CDC claims school screening for head lice is neither beneficial nor cost-effective.

The state's head lice manual is based on that national research, said Patty Lawless, an analyst with the Michigan Department of Education.

"Really, there's not a reason for a no-nit policy," Lawless said. "If the nit is more than a quarter-inch away from the scalp, there's no blood source. If there's no blood source, there really isn't any threat of them passing it along.

"I get the calls from the parents (who say) I can't get my child back in school because they keep finding one egg. Kids are missing way too much school if you're waiting for all those nits to be gone, really for not much of a threat. If a child's hair is long, it's really hard to get rid of all the nits."

Still, Lawless estimates most Michigan schools abide by a no-nit policy. That's the case in Rockford Public Schools, where Linda Rothenthaler reviews treatment measures with parents to exterminate any nits before students return to class.

"If a student is out and comes back with nits and the parents see them, they get really upset about it," said Rothenthaler, school nurse. "Before the child is admitted back to school, we have the parent bring the child in and we do look at their head to make sure. Even though the shampoos claim to kill whatever's in the eggs, what we have seen is that, within a couple hours, they have crawling bugs again."

Setting policies

The policy is less strict at Caledonia's Dutton Elementary School, which follows the guidelines of the state's head lice manual. Students identified with nits are not required to be sent home in the middle of the day nor must their heads be nit-free to return the next day.

"We don't want to embarrass the child," Principal Darrell Kingsbury said. "If they have nits, it's not something that sprung up in the last half-hour. Once we've been assured by the parents they've been treated, they can come back to school. It's really one of those social and cultural things, because there's really no danger with head lice."

Long-term tools

Painter, the Spectrum nurse at GRPS, said she does not disagree with some of the arguments against a no-nit policy. Requiring that nits be gone could be punitive without simultaneous nursing intervention, she said.

That's why nursing staff helps parents work on long-term lice prevention in tandem with a no-nit policy.

"By being nit-free, it really forces accountability," Painter said. "Our experience shows if you can get rid of the nits, you don't have this constant problem. We don't want kids to repeatedly treat with chemicals."


Winning formula

No-nit policy or not at school, home is where the real battle with lice comes to a head. Here's a laundry list of lice prevention tips:

Wash personal items, such as clothing, bedding and towels, that could get infected with head lice.

Vacuum carpet, couches and chairs.

Inspect hairbrushes, combs and barrettes and boil, if necessary.

Don't share hairbrushes, combs, hats or scarves.

SOURCE: Michigan Head Lice Manual, Press research

Finding a solution

In Fennville, Hebert recommends natural solutions, such as soaking hair in white vinegar for an hour or coating the hair with olive oil, Vaseline or mayonnaise. Or, quite literally, nit picking by using fingernails to strip the eggs out of the hair.

There are many options and one non-negotiable rule: No nits at school.

One student with lice came back to school in time for lunch, Hebert recalled. Others are out for several days.

"If we can take care of (a potential outbreak) with one person, that's not fair to the other people in the classroom (to risk it)," Hebert said. "You can take care of it. It can be done. If it gets longer than a day or two, we're on the phone checking on them."

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