Background:

In the United States, head lice infestations are most common among preschool and elementary school age chilren and their household members regardless of socioeconomic status and hygienic living conditions. "No-nit" policies that require a child to be free of nits before he/shie can return to school lack evidence of effective, results in unnecessary absenteeism and may violate affected children's civil liberties (Pontius, 2014: CDC 2015a). Unnecessary absenteeism leads to missed learning opportunities for the student and potentially lost family wages due to loss of parent/guardian workdays.

Head lice are not known to cause disease. Research has shown that the survival of head lice when not on the head is usually less than one day, and the eggs can only hatch when incubated by body heat found near the scalp (Devore et al,.2015 CDC 2015b). Transmission occurs primarily through head-to-head contact and infrequently through indirect contact with shared personal belongings. By the time and infestation is discovered, the student may have already had head lice for a month or longer (Devore et al., 2015).

Even with this knowledge, the presence of head lice can negatively affect families and schools significantly disrupting the education process (CDC.2015). Studies have shown that control measures such as mass screenings for nits, have not been shown to have a significant effect on the incidence of head lice in the school community, nor are they cost effective. Communication between school personnel and parents/caregivers highlighting cases of head lice (eg., "head lice outbreak letters") has been shown to increase community anxiety, increase social stigma causing embarrassment of affected infested students, and puts students' rights to confidentiality at risk. (Gordon, 2007. Pontius, 2014).

RATIONALE

Evidence-based strategies/best-practice head lice management rational includes.

      Educating the school community to dispell common myth about head lice.

      Elimination of mass school classroom screenings for head lice.

      Family education about how to routinely assess their children for suspected head lice as needed.

      Provide confidential screening for students and staff when appropriate for suspected cases of head lice.

      Returning affected students to class or other school sponsored activities with instruction to avoid head-to-head        contact and sharing of personal items. (Pontius 2014).

      Eliminating classroom- wide or school-wide head lice notifications ("lice letter").

      Notify parents/caregivers at the end of the school day to teach about evidence-based treatment options. 

CONCLUSION

     It is unlikely that all head lice infestations can be prevented. The burden of unnecessary absenteeism to the students, families, and communities far outweighs the perceive risks associated with head lice. Local school boards have the ability to formulate policy/procedure for their own district, but should note that head lice (pediculosis) is not a school restrictable event. 

                                                                                 UNJUSTIFIED RESPONSES

    Excluding or quarantining the student or his/her possessions.

    Violating confidentiality of the effected student and his/her famil.

    Notifying other students and parents of minor health issues affecting classmates.

    Mass screening of students for head lice and/or nits.

    Restricting the use of headphones or helmets.