Managing Headlice

PattyB RN · Jan 23, 2009

God bless you hanging in for 16 yrs! I've been a school nurse for 8 years. I work in a small city of diverse culture. From a socioeconomic point, the population is working poor, lower income, and blue collar types with a few well to do thrown in the mix. Not a wealthy community by any means. I work in an elementary school of about 550 which is located in the outskirts of town, not in the inner city. The schools in the inner city tend to deal with headlice on a daily basis. I was previously assigned to one of those schools. Here's how we handle it in our school district. We are nurses employed by the city. We work for the Health Dept. not for the Board of Ed. We have standards and policies which are governed ny our state dept. of health, and a medical advisor who is a licensed physician (he's an old time pediatrician and super smart!). Our policy regarding head lice is not negotiable. We have a "No Nit" policy which we stringently enforce. I inspect the entire class. I also send home a letter stating a case of headlice has been identified and informing parents what to look for etc. Our school principals back us up if we encounter a parent who is uncooperative. Head lice is not really a medical issue per se, it's a social issue (or public health) so if there is a repeat offender (and there always is) we involve the social worker so the student doesn't feel stigmatized and so the student doesn't miss too much school because of lice. We also have a strict attendence policy so if someone has headlice a lot, administration gets involved and meets with the parents and it's not so much all on the nurse to "fix it"! I agree with you that the headlice, once discovered, have already been there for who knows how long, but our policy is to send them home. I wish you luck. Get your school to work with you, not against you.

topsyturvy · Jan 23, 2009

I just found some great up to date information regarding head lice. Check it out..http://biotech.law.lsu.edu/cphl/practice/lice/hl-myths.htm

I have now worked long enough to have kids of students that had lice. Their kids now have lice. How do we break the cycle?

Purple_Scrubs, BSN, RN · Jan 23, 2009

I find that many of my kids with chronic infestations get their hair treated, but the family neglects to treat the bedding, stuffed animals, etc., even though I send home detailed instructions on treating everything. After a few times I try and sit down and really talk to the mom and educate on treating the home. Some of them just did not realize that you had to do this.

There was a case last year that I went to my supervisors with out of frustration and their suggestion was for me to do a home visit to see the areas that are not being treated. It never came to that, but it was the next step if the family did not get it under control.

We have a no-nit policy too, although I often fudge and wait until the end of the day to send the kid home. I think it is ridiculous for them to miss school for it, but my district does not agree. It seems that when I send a kid home, they miss a week while the parents try to get the nits out! Crazy!

topsyturvy · Jan 23, 2009

I have experienced the same and I agree with you totally. The kids that have had it since they sprouted hair are always going to have trouble with it. Sending them home only gets them behind. I have done home visits..helped clean the house..treated all family members..only for them to return a few days later with it again. It often will be in the entire family circle and as long as they visit each other.. sleep-overs and such it will continue. The main problem I have found is that the families are not removing all the nits. This has to be done and I have explained this over and over! They will argue with me saying that they did..when I'm looking at nits in all stages with some being months old. Sometimes I feel like I'm beating my head against the wall!

kidsnurse1969 · Jan 23, 2009

I agree with and follow a similar practice as Topsyturvy. I also have the greatest trouble with the hysteria of the staff on this issue. I have found that head lice is a permanent part of some families' social circle and we can do nothing to change it. Why prevent the children from learning?

I do what I can to control the hysteria with the staff by educating them every year at the beginning of the school year. I try to maintain a level head when an "outbreak" occurs. And I keep a few things quiet/secret when I can.

Sometimes, I simply comb a (chronic offender) student's hair with a metal nit comb to remove what I can and send the student back to class without further explanation. If the teacher doesn't ask, then I don't tell what I find. The only thing that would change if I sent him/her home would be that he/she misses class. Rarely does the head lice spread to other students. (I should mention that the building principal is aware when I do this.)

Frankly, there is more important work to be done that chasing bugs.

zenman · Jan 25, 2009

This is a site I like:

http://www.hsph.harvard.edu/headlice.html

Flare, ASN, BSN · Jan 26, 2009

i like that site too, zenman. we recently got away from the no nit policy. Kids miss too much school and more often than not i'm finding nit casings throughout the length of the hair, suggesting that the infestation has been going on for quite some time. The main thing that we remember is that a nit any further than 1/4" from the scalp cannot survive and any found and no longer viable. Instruct the parents to clean all bedding, hats, coats, etc and to freeze the things that can't be properly cleaned. We also have professional nit pickers in the area that will come out and de-louse a client - it's not cheap (i always joke that it will be my career once i retire :)) but we have some parents that would rather pay than pick.

topsyturvy · Jan 26, 2009

That is funny! Professional nit pickers :chuckleThat is not a bad idea really. Are they parents in the community? You know... :idea: What do you think about having a group of volunteers come out on Monday to de-louse( with parent permission of course). This would get rid of the problem right off the bat at the beginning of the week. Of course some would have to be de-loused every Monday..it may eventually wipe out the problem though..hmmmm...You think it is wishful thinking????