Lice

In August 2010, the American Academy of Pediatrics released a policy statement about the management of head lice infestations in typical K – 12 school settings. (Pediatrics 2010;126:392–403) The statement made some news headlines. It said no healthy child should be excluded or miss any time from school for lice.  Also, the policy said “no nit” policies in schools should be abandoned.   The AAP statement only applies to school age children in typical K-12 classrooms, not child care settings. However, the AAP book, Managing Infectious Diseases in Child Care and Schools, 4th edition (2017), echos this policy for child care too.

Adults who care for children in groups should know how to recognize when a child has lice. One of the main symptoms is scratching of the skin, especially behind and around the ears and at the nape of the neck, where lice bite and feed on blood from the scalp. Be careful not to mistake dandruff or other tiny debris in the hair as lice eggs (nits) or lice. Head lice are small, tan-colored insects less than 1/8 inch long. They cause discomfort, but no serious disease.

Fall is a common time for outbreaks of head lice. The primary method of spread of lice is presumed to be head-to-head contact.  Lice crawl – they do not hop or fly. However, it is reasonable to avoid sharing personal items such as combs, brushes, and hats. The child with lice does not need to go home immediately. The child can remain until the end of the day while avoiding head-to-head contact with other children. The family should start treatment before the child returns.  

Some of the treatments with toxic chemicals used to kill lice can cause more trouble than the lice themselves. None of the chemical treatments kill all the eggs that lice lay. When an infestation occurs, families and other adults involved in the care of children may get very upset. They may overdo use of chemical treatments. Families should consult with a health professional for a treatment plan. Use lice control products only as the product manufacturer’s label recommends. Some chemicals may require 2 treatments.

Nits are egg casings for lice.  They are strongly attached to hair. Only the egg casings close to the warmth of the scalp hatch lice. Combing wet hair with a special fine lice comb may remove viable nits and live lice close to the scalp. The process is tedious and time-consuming. Despite many claims, no treatments loosen the attachment of the nits. Wetting the hair makes it easier to comb and avoids flicking eggs or lice into the air. Doing the combing may help reduce confusion about whether nits seen on the hair are from a previously treated infestation or from a new invasion of lice since the treatment was done.

To educate staff and families about lice, use the Quick Reference Sheet from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 4th edition, 2017. You can purchase this publication from the American Academy of Pediatrics bookstore. If you need help to locate the specific Quick Reference Sheet about lice, e-mail your request to This email address is being protected from spambots. You need JavaScript enabled to view it.. Reviewed and reaffirmed 7/2018