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Frustrated to no end.....

Posted

Specializes in Med Office, Home Health, School Nurse. Has 4 years experience.

our county system does not have a "no nit" policy. we do however, have a policy in place that requires that children be sent home if live lice are found....

i have a k girl that i have sent home numerous times over lice. her sister is in one of the upper grades and it's been a constant struggle with her too. the parents just flat out don't care. i've sent home several informative sheets about cleaning the home and things that the children come in contact with and everything i can think of. i even went as far as to get them connected with the health department for further resources because it was becoming such a problem.

i sent the k girl home a couple of weeks ago with lice and sent home the packet containing all the information and a copy of the school board policy. parents send her back the next day with the empty box of lice shampoo and a nasty note telling me that "she must be getting it from school cause they didn't find s***. etc etc."

fast forward to yesterday, the k girl comes in around 1:30, with a note from her teacher. i check her head, and there are live bugs crawling in her hair. i call dad and he is like "okay, okay" and then hangs up on me.

she comes in this morning and immediately is itching. her teacher notices that her hair doesn't look like it has been treated (in the past, when they have actually treated it, it's cleaner and straighter). she sends her to the clinic to be checked. the girl tells me that they didn't do anything to her hair last night, except look at it. i check her head, find a bug. i call mom, she gets huffy and tells me that everyone in the family looked in her hair last night and there was nothing there at all. i tell mom i will re-check and call her back, just to hush her up. i check again, find a different bug and call back. no answer. i leave a message for mom to call me. i've called three more times, they just aren't answering the phone now.

in the mean time, i have spoke to the principal, he says she has to go home if they call back. the county nurse that floats from school to school was on her way to the middle school so i had her stop by here. we found three live lice and caught them with tape. they are now sitting on my desk. there is at least one more in her hair that we couldn't get.

i'm not going to make the kiddo sit in my office all day. i sent her to get lunch and spoke to her teacher (who is wary about the other kids getting it because this little girl loves to hug on everyone and stuff like that) and she is going to eat her lunch in her classroom.

at this point, mom still hasn't called me back. i'm really concerned that her or dad is going to get violent at some point. the principal also has that concern because he asked me to alert the school resource officer (a sherriff's dept employee who works for the school board) to come here just in case they show up fuming. however, the resource officer is off today! of all days!

this little girl has missed several days r/t lice. i've done everything i can think of....

what should my next step be???

BunnyBunnyBSNRN, ASN, BSN

Specializes in School Nursing, Ambulatory Care, etc.. Has 13 years experience.

Can you send a visiting teacher to the house to alert the parent's the child must be picked up? Can the principle contact transpo and tell them not to pick the child up on Monday? (forcing the parents to bring her to school and show proof of tx) Can you treat her at school?

Ok, with all that being said...at some point, you are going to have to decide that this family is chronic and just educate the children to keep their hair pulled back, not share jackets, brushes, etc, and pray that when they grow up and can take care of themselves, they will. I have a couple in my school that are chronic licers and I've gotten to the point that I just don't send them home. I send home a letter and an info sheet, but other than that, I would rather these kiddos stay in school and (hopefully) get an education so when they grow up, they can decide not to live this way. We get out of school at three, so I save my head checks for 2:00p when I can. That way, I can call the parent and send a letter home - I'll even put them on the bus "since school's almost out and you'll treat her at home tonight". :D

Good luck!

LACA, BSN, LPN, RN

Specializes in Med Office, Home Health, School Nurse. Has 4 years experience.

The parents showed up out of the blue about an hour ago to pick her up. I wasn't here, I was at the high school doing drug testing.

I can't treat her at school due to liability issues.

I've even gotten to where I wait until the end of the day to check most of the time. But when she's digging at her head and complaining that it itches, I can't NOT check her. I can't leave her at school when she has live bugs because at her age, they love to "love" on each other and stuff and it would be impossible to keep her from all the other kids, unfair even. I guess I will have to wait and see what they say on Monday, if they bring her back.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

We abandoned our no nit policy a few years ago. However, if a student is sent home because of lice, they may not return to school unless rechecked by the school nurse with a parent present. If lice are found they must take and treat he child immediately. Can't even check in to class. Because of the ongoing nature of this, you may want to consider getting a doctor involved as well. If you are worried for your safety, definitely ensure that principal and/or the school resource officer is present for all encounters with these parents.

LACA, BSN, LPN, RN

Specializes in Med Office, Home Health, School Nurse. Has 4 years experience.

I'm definitely worried about my own personal safety at this point. Both of the parents have shown some anger towards me, and I don't want it to escalate. I don't think it would do any good to even attempt to get a doctor involved, they aren't going to care. The principal and the resource officer are both backing me and they are aware of the situation.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

Well, i know it's not what you want to hear, but if they continue to ignore the lice situation, it warrants a call to child protective services. I know it would throw a cup of gas on the fire so tread lightly.

rdsxfnrn

Has 10 years experience.

i agree with previous poster. the child is not being provided with a safe clean enviorment. you are mandated to report it. you can get in alot of trouble for NOT reporting.

Purple_Scrubs, BSN, RN

Specializes in School Nursing. Has 8 years experience.

Someone told me recently that lice alone is not a reason for CPS to investigate a family (or reason alone for someone to report). Anyone else heard this?

luvschoolnursing, LPN

Specializes in School Nursing. Has 23 years experience.

As far as I know, CPS will not investigate this. Our county health dept. considers it a nuisance, not a health concern. We have had parents call the health department to report us (the school nurses) because we would not release the names of who had lice. Lice seems to cause more panic than HIV, TB, H1N1 and MRSA combined!

rdsxfnrn

Has 10 years experience.

in CT, where I am, you must report ..... not for the nits, but for child neglect..... "......being denied proper care and attention..." straight off the back of the DCF paperwork...... btw, the thought of that makes my skin crawl. poor kids.... there is no liability to mandated reporters if they make the report "in good faith"

jagalu100305

Specializes in School Nurse, NICU. Has 7 years experience.

i have called CPS before re a student with CHRONIC head lice and also missed a week of school because mom didn't feel like treating it and they told me it was a truency issue and wouldn't do anything :(

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

i understand that lice is considered a nuisance, but this probably merits a home visit to see if the living conditions are santary. Also - the untreated lice *could* cause an infection if lesions on the scalp are not properly treated.

Artistyc1

Specializes in School Nurse, Maternal Newborn. Has 35 years experience.

i agree with previous poster. the child is not being provided with a safe clean enviorment. you are mandated to report it. you can get in alot of trouble for NOT reporting.

CPS may or may not take the call, even if you did hotline. Head lice is not an offense that they will usually deal with, at least in NY state. Head lice are NOT a public health or safety issue for the child, they do not spread disease, they are nuisance. As are the parents you are dealing with, may I add! This child is not at any risk of injury for having lice, so good luck with CPS.

Only if I suspect a child is in imminent danger will I call CPS and add in "they just don't seem to be doing anything about the child's head lice, no matter what I do to try to educate, cajole them, I give them a timeline for the problem, etc. " They will take that along with the other information, but it won't stand alone.

I deal with several parents like this all the time. As it is not a good idea to keep the child out of school (heaven knows they are not likely to receive any constructive education at home) our district has adopted the Harvard School of Public Health Protocol. If you find live lice or nits, tie the childs hair up, and call the parent before the end of the day, send them back to class. We educated our teachers and staff on the life cycles of lice, and how they can avoid it if it is in their classrooms. I add to the process the following: Tell the child to avoid head to head contact with anyone, due to concerns about spreading lice, and I use a Licemeister or other fine tooth metal comb with long teeth to remove anything that may be living on the child's head, to the best of my ability. ( boil and scrub them with an old toothbrush between children.) It IS time consuming, but making a kindergartner a pariah for the parents negligence just seems cruel, in my opinion. :twocents:

Artistyc1

Specializes in School Nurse, Maternal Newborn. Has 35 years experience.

Someone told me recently that lice alone is not a reason for CPS to investigate a family (or reason alone for someone to report). Anyone else heard this?

Yes, been there, done that, got the t-shirt. They won't take the call. Lice are annoying, but not a public health issue. It is an emotional thing that so many parents worry about, but that is often mainly ignorance about lice in the first place. Many don't know that they don't jump or fly, for instance. They don't know that cleanliness is not part of the equation, and that they can happen to anyone.

A lot of the fear comes from old and erroneous information about how only dirty and slothful people get it, thus the social stigma.:twocents:

Edited by Artistyc1

What does dad do that he is home when you call? are parents unemployed? It might be a cost issue.

I think it is too late for this now, but I'd have done a home visit. It would not be safe for you to do so now alone, but perhaps a team could go out.

It is possible this goes beyond lice. Is she otherwise clean and dressed appropriately?

"...sent home the packet containing all the information and a copy of the school board policy" I posted once before where we had a parent that was not doing what we asked, and for months we were really frustrated, until the day I found out the mom could not read a single word, had a severe learning disability. We already knew Dad was a drug dealer. I am sure he did not read the stuff we sent home. The kids were eventually removed from the home.

Last resort, is it possible that you comb her so she can stay in school? if we are talking 3 or 4 lice, she could end up being held back if she misses weeks and weeks of class for just a few critters.

SchoolNurseBSN

Specializes in school nursing. Has 4 years experience.

When dealing with uncooperative parents, I always try my kill them with the kindness act. "What can I do to help you?", "It must be tough for you to deal with this situation."etc. Sometimes that works, sometimes it doesn't!

LACA, BSN, LPN, RN

Specializes in Med Office, Home Health, School Nurse. Has 4 years experience.

Home visits have been made, our system has a individual who makes home visits based on neglect and other issues and speaks to the parents. He has told these parents repeatedly that they need to take care of the lice problem. I have given them a contact at the local health department who gives them the shampoos and other items for free, so it's not a cost issue for them anymore. They are just being defiant now and not taking care of it. The little girl was back in my office this morning and her head is clear for now, but by the end of the week, it will be full of nits again. I think I'm just going to start combing her hair out on my own. It's ridiculous for her to miss this much school, she's on the verge of truancy now and if she misses X number of days for lice, the court is going to get involved because it falls under truancy. She is very very close to that number, so I guess I will just have to wait and see what happens.

Our CPS will not deal with chronic head lice cases because head lice "do not cause illness, injury or disease" and therefore are not considered a "problem area". Our truancy team cannot get involved because it is the school sending the kids home repeatedly, not the parents keeping the kids home or the kids skipping school. I will offer to make a home visit and check the heads of the parents and anyone else in the home or visits frequently. Teachers really freak out and do not want head lice in their classroom, so often these students are left sitting in the office waiting for a parent to pick them up for the umpteenth time. I believe your principal needs to take a stand and tell this family that this child cannot return to school until there is no more live activity (or nits within 1/4 -1/2 inch from the scalp as surely they will hatch during school hours!!) Good luck!