Dealing with head lice in school children

Head lice infestation is associated with little morbidity but causes a high level of anxiety among parents of school-aged children. The American Academy of Pediatrics (AAP) attempts to clarify diagnosis and treatment of head lice and makes recommendations for dealing with this condition in school. Head lice are most common in children 3 to 12 years of age, and all socioeconomic groups are affected. Head lice infestation is not significantly influenced by hair length or by frequent brushing or shampooing. Lice cannot hop or fly; they crawl. Transmission in most cases occurs by direct contact with the head of another infested individual. Indirect spread through contact with personal belongings of an infested individual (combs, brushes, hats) is much less likely, but cannot be excluded.Among its recommendations, the AAP says no healthy child should be excluded from, or allowed to miss school because of head lice, and that "no nit" policies for return to school should be discouraged. Although not painful or a serious health hazard, head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work.

The AAP recommendations for treating head lice include:

• School personnel responsible for detecting head lice should be appropriately trained, as it can be difficult to diagnose. 
• Permethrin 1 percent (an insecticide) is currently the recommended treatment for head lice. 
• Head lice screening programmes in schools do not have a significant effect on the incidence of head lice, and are not cost-effective. Parent education programmes may be a more appropriate management tool. 
• Manually removing nits (the eggs or young forms of head lice) after medication for killing lice is not necessary to prevent spread. However it may be prudent to remove nits in school-aged children to decrease the chance of mis-diagnosis. Nit removal is tedious and often cannot be accomplished in one sitting.

Currently there are a variety of treatments available for head lice including solutions in shampoo and cream rinse formulas, topical agents and manual removal. The AAP recommends Permethrin 1 percent as it has low toxicity for humans and does not cause allergic reaction to individuals with plant allergies. The product is a cream rinse applied to hair that is first shampooed with a non-conditioning shampoo and then towel-dried.
It is probably impossible to totally prevent head lice infestations as young children frequently come into close head-to-head contact with each other. Children should be taught not to share personal items such as combs, brushes and caps. Adults should be aware of the signs and symptoms of head lice infestation, and affected children should be treated promptly to minimize spread to others.