Lice, I know, old news. But need opinions!

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I am a new school nurse and have a student and her sister that chronically have lice. The nurse last year did multiple treatments at school for these girls (with parent and principal approval, of course) and have educated the parents multiple times on how to get rid of lice. Nothing has worked. Well, this year, we have the same problem. Our lice policy is a no live lice, nits are ok to remain in school. We are seeing a lot of live lice in her hair and not only is compliance an issue with trying to help these girls rid their hair of lice, but we cannot get a hold of parents when we call them to tell them that they need to pick up their girls. So they sit in the health office with my health tech until the end of the school day. Now, the principal has proposed an idea to have these girls sit in my office until the end of the day if we cannot get a hold of parents, which is going to be everyday. They will get their school work and work on it in my office. These girls also have a lot of energy so the health tech does not want them in her health office with the other kids. I don't know what to do here and I need as much advice as anyone can give. The solution the principal came up with is not solution based and is not any help to the 2 girls.

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Specializes in School Nursing.

Wow- I could have written this. We have THREE girls (K-5th grade) that have had lice their whole lives (this issue started when the 5th grader was in PK at this school). There are pages an pages of health office visits on these girls lice (and scabies a few years back). I have had to send them home 5 or so times so far this year, and they have sat in my office for HOURS while we wait to get in touch with someone. Even after I instructed mom to BRING THEM TO ME PERSONALLY so I can check them the next morning, they got sent on the bus, hair still filled with nits (only a few less live bugs than the day before), and they end up in my office for hours again waiting for mom to pick them up (after that fiasco she did make a real attempt to clean them out, they came back with no live bugs, but still heads full of nits). When mom picked them up that day I noticed she had hair crawling with them too. :(

I'm of the opinion nothing I do is going to end this issue with this family. Mom said that she's tried everything, every over the counter, prescription and "natural" cure out there and nothing works. I have educated her on following up treatment one week after the first, nit removal, teaching kids not to share hats, brushes, combs, given her step by step instructions, etc. etc. but it's painfully obvious she has either given up completely, or doesn't care (I'm truly not sure which). This woman is young (26 or 27) and has seven kids ranging from 1-15 years old. This is a poverty stricken family. The children are sweet and smart, and I don't believe they're being abused.. this is just.. how they've always lived, and I think this is how mom has always lived.

The principle hinted to me that maybe I could delouse the children so they didn't have to miss anymore school (the last school nurse did this in the past). I really don't think that is a solution to this issue either. I'm really at a loss, just like you.

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If it is their education on the line, then they should sit in the principal's office where they can get primo instruction!

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Specializes in Maternal - Child Health.
If it is their education on the line, then they should sit in the principal's office where they can get primo instruction!

I respectfully disagree.

Prime instruction happens in the classroom, not in any office. The classroom is where these students belong.

This is one of my soapbox issues. For those who've endured my posts before, please scroll. Otherwise, here goes: Nurses are often the sole healthcare providers in schools. As such, it is our duty, to our own profession as well as to those we serve, to base our practice upon current scientific knowledge and principles of public health. Both tell us that there is nothing harmful about students with lice (even live infestations) attending school. They pose no risk of transmission to other students so long as a few basic health and hygiene standards are enforced such as no sharing of grooming items, hats or linens, none of which should be happening in the school setting anyway. Furthermore, other than the possible distraction of an itchy scalp, lice pose no health threat to the sufferer, either.

While I realize that the school nurse is often not the individual responsible for setting school policy regarding attendance, it most definitely IS the responsibility of the school nurse to educate those who write such policies and to advocate for the students and families who are negatively impacted by policies that are woefully outdated. Instead of wringing hands over whose office these students sit in for hours waiting to be taken home for yet another round of ineffective and irritating chemical treatment, how about we work on getting them back into the classroom where they belong. Once they are there, we can use our time to contact local health department experts or the biology department of the local university for evidence-based, scientifically sound information to share with our school staff and parents on the most effective and least disruptive methods of eradicating head lice.

I am not a litigious person, but I would strongly encourage any parent whose child is denied access to a free and appropriate public education to pursue redress via the court system. Unfortunately, this seems necessary because so many school districts refuse to update policies and continue to ostracize students with a harmless (albeit unpleasant) condition that poses no risk to themselves or anyone else.

Stepping down from my soapbox now. Next lecture: unvaccinated students. I bet you have more than a few of those in your building(s), yet it is the poor kid with the itchy head who gets sent home!

ETA: Resistance of lice to common chemical treatments is now widespread. I believe I read an article at the start of the school year indicating that this problem has been documented in 49 states, with Michigan being the lone exception. So cases not responding to OTC or even RX treatments will become more common. That doesn't justify excluding them from school, rather argues against such draconian measures for a non-threatening condition that may not quickly improve with treatment.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Amen a thousand times to what Jolie said. Look at what the APA recommends as far as lice and school policy.

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Specializes in School Nursing.

I've educated my administrator on the latest CDC and PHD recommendations and the reasons behind it. She was having none of it. It's the first suggestion I made when she asked me, "How can we help these kids stay in school". She is of the belief that these kids are too close day in and day out to not spread it like wildfire.

Maybe if I print out the studies and give them to her. I'll try!

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Specializes in Pediatrics Retired.

I realize GmaPearl was being sarcastic; of which I agree!!! But really, Schoolnursesrock1, as eloquently explained above, your school policy and treatment of kids with head lice goes against every recommendation of every group, association, medical advisory board, etc...except hysterical parents who would agree to put those kids in a tent outside and feed them with a tray on the end of a stick. You can not eliminate head lice from school - bottom line.

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Specializes in School nursing.

Link to the NASN policy on lice - I used it with my boss (who is not a nurse) and it worked.

https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/40/Pediculosis-Management-in-the-School-Setting-Revised-2011

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Specializes in HH, Peds, Rehab, Clinical.

Social services. Seriously. There are clearly issues at home that are not being dealt with.

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I gave my boss the positions of the NASS, the CDC and the American Academy of Pediatrics. He handed them back to me and said ," no nits." There was no discussion to be had. Our administration does not want to hear best practice because they bow to the demands of the parents.

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Thanks so much everyone. I used a lot of your ideas when talking to the principal today and now she is bringing it to the school board tomorrow to get our policy updated to the current recommendations! I appreciate all the feedback. Thanks!

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Specializes in Community and Public Health, Addictions Nursing.

Those good ol' head lice! Not a school nurse, but I've dealt with this problem from the other end- the pediatrician's office. Perhaps you could put in a call to their doctor and give the heads up about a recurrent lice problem? This won't be the only solution, but perhaps one piece of the puzzle is going to be finding a different type of lice treatment besides Nix or Rid to use. Maybe some Ovide or Sklice is due to be tried next.

I don't know how well the parents are doing the treating/combing/housecleaning, but if they seem overwhelmed, under-resourced, etc., maybe having you treat and comb at school will give them a better chance to clean the home thoroughly.

I also agree that having these girls sit in your office day after day is unnecessary and detrimental to their learning. If official policy states nits only, though, and no live lice, then I guess your hands are tied until the right people approve a policy change.

As for contacting social services...all I'll say is that plenty of families have difficulty trying to manage their children's head lice problem. But at least they try different treatments and communicate with their healthcare providers about it. It is NOT ok to disregard calls from health professionals such as yourself about this problem. Have they even told you or the pediatrician about what treatments they've tried so far, and asked for help themselves?

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