How do YOU check for lice?

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Specializes in med-surg, IMC, school nursing, NICU.

I know there are dozens of threads regarding this itchy, annoying, emotional topic but I am interested in an up-to-date response regarding how you check for lice themselves.

The reason I am asking is because I have a parent who kept her child home from school today. The student was treated on 10/16 and began coming to me for daily checks (for 2 weeks, as per our policy) on 10/17. I haven't seen ANYTHING since then. She has insanely thick hair so I really take a few minutes and look through her head. A few nits were found the first day but mom combed her out and since then she has been good. Yesterday afternoon mom messaged me saying "Little Susie has nits, I am taking her to a lice clinic tomorrow." This afternoon she sent me a photo of a cup full of what I am assuming are dead lice saying "This came off of Susie's head."

I don't get it! Am I missing something? She really had NOTHING that I could see yesterday morning. I parted her hair in several spots, used a light, used a little stick to separate the hair, checked at the nape of the neck and behind the ears. I truly didn't see anything and now I feel dopey. I'm sure mom thinks I'm a total flake (especially since she and her family worshiped the previous nurse) for not seeing this but I like to give myself enough credit to think that I would have seen all of those lice yesterday AM.

How do you guys usually check for lice? Do you do follow up checks after an infestation? I'm just looking for some insight as to how I could improve my practice.

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Specializes in Pediatrics Retired.

Keep in mind that OTC lice treatment only kills live lice so the nits will continue to hatch live lice. The trick is to do a second treatment "after" all the eggs have hatched but before the lice are mature enough to reproduce; which is about 14 to 17 days. The treatment instructions say to repeat in one week. I tell everyone to wait 10 days to be sure all of the nits are empty. If one follows this treatment scheme and doesn't get re-infested from another source you don't have to pick one nit. The empty nits will grow out on the hair shaft and eventually deteriorate or get cut off with a haircut. Of course some folks can't abide by the thought of empty lice eggs in their child's hair.

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Well here's the thing. It's not YOUR responsibility to make sure her kid stays/is lice free. She could've picked up something after you checked her or maybe one or two nits hatched and began the whole process over or they finally got big enough to see well. Either way, I always tell the parents I only have time for a quick screening but YOU need to be thorough. YOU need to check your child daily, weekly, etc. I don't know why that's your policy. That's taking responsibility away from the parent.

And yes, I have missed lice before even after checking thoroughly. Sometimes they're just too tiny, match the hair color too much, or maybe the hair is just so thick. Those little suckers move fast and avoid the cold air as I part hair. Plus I just don't take a long time to check. I just don't have time for that.

Don't feel stupid. It happens and why didn't the parent catch it before that point? Probably because they expect you to. They aren't yours to raise. Even if that's your policy, change it around to making the parents responsible and you as just a back up in case THEY missed something!

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Specializes in Telemetry, Gastroenterology, School Nrs.

So, why are you to blame and why is it your responsibility to check her every single day? What is the parent's role in all of this? Seems to me if the child was being checked at home, then if you did miss something (which absolutely happens all the time), a check in the evening at home may have caught something your eye missed. Don't beat yourself up about it. Most parents are looking for an easy fix, when really it takes a lot of work and consistency to completely get rid of those little creepers.

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Our policy for lice is: If lice are found by me, the child's parents are notified by the end of the day-the child is not excluded. If found at home-well, most parents won't tell me anyway. The child may return to school after being treated. They should bring in the box top from the treatment and be checked for effectiveness by me. If the child is not crawling with live lice, they come back to school and I do not recheck until 10-14 days later. All cases of lice found by me get a letter home that explains that PARENTS must be diligent in checking for re-infestation and treatment effectiveness. This is NOT a school issue, it is a home issue and I'm so glad that our policy supports that!

I do quick screenings for lice. Part the hair, use a light, I usually ask where they have been itchy the most and start there.

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Specializes in school nursing, ortho, trauma.

I have been bestowed a brandy new lice policy this year and i'm still working out the kinks. The teachers don't like the fact that I no longer HAVE to blindly check an entire classroom because of one case found in a room (i am doing a happy dance). I won't undo someone's hairdo - so that means that girls with tight buns and ponytails and plaits probably won't get the sticks run through as thoroughly as the girl with their hair down. I may be a lot of things around here but hair dresser definitely not one of them.

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I ask where its itchy, and I part and really get in there. I use a lighted magnifier to really make those bugs BIG! :eek: Then I wash my hands really well. If I see nits or live lice, home goes a packet on mythbusters, how to clean hair, how to handle environment, a letter to sign and return and usually a follow up phone call. I always let the parent know I'm willing to help in any way I am able.

Its a big problem here, and one that continues to spread due to complacency at home, unfortunately. Most parents that I am able to follow up with "I don't clean house" or "got tired of combing" or "they wouldn't sit still" or "I didn't feel like it" or "I combed until 2 am!" some other nonsensical reply when the student is obviously totally crawling and its not a fresh new hatching.

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don't beat yourself up about it - the parent should have been checking all along too and should have found them before you.

If I find the lice or if a parent reports lice, kid gets sent home but may return the next day as long as they have been treated and I do not find live lice - nits are ok. I do not check again until a week later after they were supposed to do the 2nd treatment - if I do not find live lice my checks are done unless the parent states they haven't gotten rid of them.

I do not check for rumored lice or if a parent calls me and tells me about someone else's kid that is rumored to have lice.

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Specializes in med-surg, IMC, school nursing, NICU.
Well here's the thing. It's not YOUR responsibility to make sure her kid stays/is lice free...

...Don't feel stupid. It happens and why didn't the parent catch it before that point? Probably because they expect you to. They aren't yours to raise. Even if that's your policy, change it around to making the parents responsible and you as just a back up in case THEY missed something!

And truly, this is all I needed to hear. I think just constantly being spoken to like these lice cases are my fault is getting to me. I swear, some of these parents act like all of their responsibility for these kids goes out the door while they are at school. New flash: they are yours, 24/7. You are accountable for their "wellbeing" all the time!

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After treatment, we only check the first day back for live bugs. If none seen, they can stay. No further testing done- unless they are symptomatic/ itching. You are doing ALOT more work.

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Specializes in med-surg, IMC, school nursing, NICU.
After treatment, we only check the first day back for live bugs. If none seen, they can stay. No further testing done- unless they are symptomatic/ itching. You are doing ALOT more work.

Yes, I thought it seemed excessive but it's the policy so that's what I am doing. That's part of why I was curious to see what other schools did.

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Specializes in Telemetry, Gastroenterology, School Nrs.

I'm sorry- I just realized I never really answered your question :)

I normally start with the hotspot down the back center of their head and then behind their ears. I do quick checks, but will take a little more time if I'm checking a student who is what I call a "frequent flyer". If the student has nits only, I will send them back to class then call the parents to let them know they need to be treated. We do not exclude for nits. If I find live ones, the student is sent home. I recheck on the initial day back after treatment and then that is all.

I don't entertain calls from concerned community members and I don't do full classroom checks.

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