WEST VIRGINIA COUNCIL OF SCHOOL NURSES
RECOMMENDATIONS
For
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.
Devised: December 27, 2006
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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:
 The school nurse, the most knowledgeable professional in the school
community regarding pediculosis management, will train school personnel
responsible for detecting head lice.
 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.
 The parent or guardian will be educated as to the appropriate health
information for treatment and prevention of pediculosis.
 The student will be permitted to return to the classroom when they are lice
free.
 The student will be rescreened as necessary to detect the presence of live lice.
 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: December 27, 2006
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References:
Centers for Disease Control and Prevention. (May 2001). Update on Head Lice in Schools:
Do ‘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.
Devised: December 27, 2006
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