stressing over lice

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I worked as a medsurg nurse for 2 years before becoming a long term sub school nurse. Here is my problem - I have never seen actual nits/lice. I have seen them in books and videos on the internet - but, that is not the same. I have had to do lice checks for 2 entire classrooms and did not find any lice/nits. One child was in the clinic twice complaining of her head itching. I looked - but did not see anything - sent her back to class. 2 weeks later her mom calls the principle - the child does indeed have lice. The parents treated and sent her back to me to check. I "think" I found some nits because they were brownish and were hard to remove from the hair shaft. Because our county has a no nit policy, she was sent home. So, now I am so stressed out over this lice thing. I keep thinking that I somehow missed some students in the classes I had to check. Should I recheck them? Please give me advice on how you check at your schools. Thanks for your time!

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Specializes in School Nursing.

Once you see 'em, you'll get used to 'em! You didn't do any thing wrong. If a kid has one or 2 lice you may miss them and before you know it, well, the little suckers breed fast. In the school district where I work, if we find live bugs, we check that particular class, we don't get too excited about nits, though.

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Do you have a lice comb? I would not send a child home for a few "possible" nits, no nit policy or not. Research has shown that few are really skilled at recognizing nits. Nurses are better at it than physicians or parents, but are still wrong 30% (false positive) of the time.

No nit policies are outdated and the research shows they make no difference in reducing lice outbreaks. No nit polices are against American Academy of Pediatrics and National Association of School Nurses guidelines.

Dr. Richard Pollack at the Harvard School of Public Health is a lice expert - some information: http://www.hsph.harvard.edu/headlice.html

Images of lice and nits: http://www.hsph.harvard.edu/headlice/photos.html

Pollack, R.J., Kiszewski, A.E. & Spielman, A. (2000). Overdiagnosis and consequent mismanagement of head louse infestations in North America. Pediatric Infectious Disease Journal. 19(8), 689-93; discussion 694.

AAP DISCOURAGES "NO NIT" POLICIES FOR SCHOOL RETURN (2002): http://www.aap.org/advocacy/archives/septlice.htm

National Association of School Nurses Position Statement (2004): http://www.nasn.org/Default.aspx?tabid=237

American Journal of Managed Care:

http://www.ajmc.com/Article.cfm?ID=2707&CFID=1607025&CFTOKEN=69437281

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If I have a question about whether I am seeing nits or not, I ask the student to pull out a strand that looks like it has an egg, (that I have separated) and I look at it under a microscope. The science lab has been kind enough to leave me one on loaner (one with a plug-in light, not a mirror) along with a few slides/covers. A nit will look exactly like the photos on the internet. This will help with an initial identification, but not necessarily after treatment. Once treated, dead nits should easily slide off the hair shaft. It's actually pretty cool to look at a louse under magnification as well! I always share the view under the microscope with the student in question, using it as my "teaching moment". It seems to increase their motivation to comply with every aspect of treatment.

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Specializes in Most all.

I enjoy looking at them under a microscope also. It is a great way to see intestinal peristalsis.

go to http://www.headlice.org

I tell my parents over and over again I do not care what product they use, just use a good nit comb (rid is my favorite, red with round metal teeth) and get them ALL out. Break the life cycle.

On days that I have been overwhelmed with "stuff" I will go find a child who probably has lice and bring them back to my room. I close the door, put in a movie, wear my hot pink apron, put on my you go girls cape, paint her fingernails and comb until I have everything out.

I want her to feel like a princess.f

Yes, I am weird!!!! You have to be in this job. :welcome:

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