2009
RECOMMENDATIONS
PUBLIC SCHOOL LICE POLICY/PROCEDURE
Head lice (pediculosis capitus) are small parasitic insects that live on the scalp and neck hairs of
their human hosts. Physically they have remained unchanged for 2000 years. Lice are not a
serious health threat because they do not cause illness. Complications related to infestation
are rare; pruritis (itching) is the most common problem.
The West Virginia Council of School Nurses (WVCOSN) recognizes the importance of regular
school attendance and the maintenance of a learning environment conducive to the academic
success of children. According to the National Association of School Nurses (NASN), “nit-free
policies disrupt the education process and should not be an essential strategy in the management
of head lice” (NASN, 2004). A study of attendance records found that 12 to 24 million school
days are lost annually in the United States due to exclusion of students for nits. Exclusion for
any reason has been correlated with truancy as well as with poor academic performance.
According to the American Academy of Pediatrics (AAP), “screening for nits alone is not an
accurate way of predicting which children will become infested.” In a study of 1729 students
who were screened for head lice, 91 were found to have nits. They found that those children
who had more than 5 nits within 1 cm or ¼ of an inch of the scalp were more likely to
develop an infestation and then only 1/3 of those in that group actually developed an active
case of lice (Williams, 2001). The presence of nits does not indicate active infestation;
exclusion of these children for nits alone would have resulted in them missing school
unnecessarily and could result in poor academic performance.
According to the AAP, head lice screening programs in schools do not have a significant
effect on the incidence of head lice and are not cost effective. A more appropriate
management tool in controlling head lice outbreaks within the classroom would be a parent
education program.
The WVCOSN recommendation for the treatment of head lice includes:
¾ The school nurse, the most knowledgeable professional in the school community
regarding pediculosis management, will train school personnel responsible for
detecting head lice.
¾ Lice or nits less than ¼ inch or 1 cm from the scalp, then the parent or guardian
shall be called and made aware of the situation.
¾ The parent or guardian will be educated as to the appropriate health information
for treatment and prevention of pediculosis.
¾ The student will be permitted to return to the classroom when they are lice free.
¾ The student will be rescreened as necessary to detect the presence of live lice.
¾ Classroom screening is NOT warranted.
Conclusion: Data does not support the exclusion of children for nits. No disease process is
associated with head lice; therefore pediculosis should not disrupt the education process.
Students found with live head lice should be referred to parents or guardians for proper treatment
and reevaluated as necessary to prevent a recurrence. Therefore, it is the recommendation of
the West Virginia Council of School Nurses that “No-Nit” polices be eliminated.
Devised: 2006
Revised: 3/26/09
References:
Centers for Disease Control and Prevention. (May 2001). Update on Head Lice in Schools:
‘No-Nit’ Policies Work? Retrieved on March 2005 from
http://www.cdc.gov/ncidod/dpd/parasites/lice/factsht_head_lice_treating.htm#tret_pets.
Frankowski, B.L., & Weiner, L.B. (2002). Head Lice. Pediatrics. 110(3) 638-43. Retrieved
on March 16, 2006 from http://pediatrics.aappublications.org/cgi/reprint/110/3/638.
National Association of School Nurses. (July 2004). Position Statement. Pediculosis in the
SchoolCommunity. Retrieved on November 3, 2005 from
http://www.nasn.org/Default.aspx?tabid=237.
Pollack, Richard J. PhD. (August 9, 2000). Head Lice Information. Harvard School of Public
Health. Retrieved on January 25, 2006 from http://www.hsph.harvard.edu/headlice.html#harm.
Williams LK, Reacher A, Mac Kenzie WR, Hightower AW, Blake PA. (2001). Lice, nits and
school policy. Pediatrics 107:1011-1015. Retrieved on January 2006 from
http://pediatrics.aappublications.org/cgi/content/full/107/5/1011.
DISCLAIMER:
The “Recommendation” of the West Virginia Council of School Nurses (WVCOSN) is not representative of
West Virginia State Code or West Virginia State Board of Education recommendation or policy. This is a
recommendation based on consensus, evidence-based practice reviews and current research from the
WVCOSN. The WVCOSN is set forth by W.Va. Code §18-5-22.
The certified school nurse is responsible for utilizing nursing judgment and skill to determine the safest
delivery of health care on an individual case-by-case situation in the West Virginia public school setting while
protecting the welfare and health of the student. Every situation is unique and requires a collaborative team
approach lead by the certified school nurse, which includes, but not limited to, the student, parents/guardians,
school administrator, experts in the field and the student’s primary health care provider, at the local level.