Student with Lice - what to do?

[tictac]

This is my first year as a school nurse...and I love it, for the most part. I'm thankful for this board and so relieved to see that we experience the same issues everywhere! Please forgive me for the long post...

I recently had a little girl who was sent to the clinic for a lice check, and sure enough, had live lice. I've had to call her mom in the past when she had a fever, and I remember it being a huge ordeal to first, get ahold of her, and second, for her to get off work. She begged me to speak to her boss and explain the situation. She works at a grocery store and doesn't seem to have a very understanding supervisor. She also walks to work everyday because she has no car. I called the mom and told her she needed to pick her daughter up due to the lice. She was practically in tears because her boss was going to be upset and she had just arrived at work. She would now have to walk to pick her daughter up as well. She said she had no one who could pick her daughter up for her. She begged me to just keep her in the clinic and send her home on the bus with something (a bag) on her head. I told her that I really couldn't do this, particularly putting her on the bus. I'm not really sure of the district policy, but I assume if they can't be in class, they can't be on the bus either.

I felt really heartless, but I didn't really have any suggestions or help for this woman. I just kept the girl in the clinic, waiting for mom to call back, like she said she would. When I got a moment, I told my principal about the situation, and she said that I should just let her ride the bus home since she came to school on the bus. She said in our school, we have to make exceptions sometimes due to our families' socioeconomic status. Well, I called the mom back, but she'd already left work. She arrived at the school and picked her daughter up.

The next day, guess who's back in the clinic first thing in the morning? Unfortunately, I checked, and sure enough, she still had some live ones in there. Her mom did use lice shampoo and used the lice comb I gave her. She'd also cut off several inches of her hair. So, I called mom's cell phone and just left a message. I wasn't going to call her job again. I fully intended for the girl to spend the entire day in the clinic and even got all of her classwork from her teacher. Mom got the voicemail though, and surprisingly, came to get her. She did have to call in to work though. She said she spent her last $10 on the lice shampoo the night before, so I told her about the home remedies that I knew of.

What would you do in this situation? I don't want to seem heartless, but obviously this girl can't keep coming to school with lice. The girl said that her mom has it too. I gave her all of the information I have on getting rid of lice in the home, etc., but I'm not sure if she's following through with it. I feel just awful calling this woman to come get her daughter. I'd buy her some shampoo myself, but I'm afraid it will become expected of me. I'm sure some of you more experienced nurses have had situations similar to this. Anyone have any advice? Thanks in advance.

[Jolie, BSN]

This site has all the information you need.

http://www.cdc.gov/parasites/lice/head/

3 important points:

Children with head lice (even live lice) do not need to be sent home from school.

Do not retreat any sooner than the product specifies. Using medicated shampoo too frequently will not clear up the infestation any sooner, but will cause terrible irritation of the scalp.

Nightly combing is the most effective way to remove remaining lice and nits.

If your family needs assistance, perhaps the school has a "petty cash" fund to help purchase products for re-treatment in 7-10 days.

[schooldistrictnurse]

Be sure you know your district policy re: exclusion.

I agree with Jolie about the funds that might be available if you just ask--I know in one of our district buildings a gas card was purchased for a family with special circumstances. Don't buy the items yourself or you will find yourself with no money at the end of the month!!! Good luck

[Flare, ASN, BSN]

Right - Lice are considered a nuisance, not a communicable disease. Depending on school policy she could stay in class, but be sure she is not doing any type of activity that would promote spreading of lice. A retreat is typically not done right away, though I usually suggest a vinegar and olive oil treatment to get the last few stubborn nits. Also - when mom comes in, be sure to check her and remind her to treat the other possible vectors like pillows and towels.

As far as supplying treatment - i know that the lice shampoo companies have sent me sample boxes from time to time over the years, or at the very least have sent me coupons. Contact them and see if you can get a few boxes of samples sent to keep on hand, should you run into a financial hardship again.

[LACA, BSN, LPN, RN]

It all depends on YOUR district. Some districts still require children to be excluded from class/school if they have lice, regardless of what the CDC recommends. Our state just recently changed the laws to where children aren't excluded at all for live lice.

Our district has a fund that they buy lice shampoo and other necessary items like that out of for families that can't afford it. I work in an area that is quite poor and rural, and lice is sometimes a common problem because many families don't have the $10-$15 to shell out for stuff like that. I'm lucky because I can't imagine not having the $ to spend on something that I consider not a huge financial burden, but to some families, $10 is all they have.

[Heidi the nurse, BSN, RN]

We have a no nit policy, and when we even brought up the subject of changing it with the district, you would have thought we wanted to keep kids in school with the plague. Its so frustrating. And a couple other words I can't write in a public forum:)

As others have mentioned, mom is going to have to do alot of work. My girls had lice when they were in day care (me too). It took months - the shampoo didn't work. As mentioned by Jolie, the only thing that finally got rid of them was nightly combing. I also spent hours with a pair of scissors cutting nits out because the day care had a no nit policy too and I wasn't able to get them off their hair any other way.

[BabyLady, BSN, RN]

Here is the real problem: That mother doesn't have enough resources and needs help. I personally, would do a social services consultation...not because the mother is willingly neglecting her child, but she may have access to resources she may not realize she can qualify for.

If that kid is having trouble getting lice treated, then what does the mother do when she has a major illness? How does she get to the Pediatrician?

I wouldn't do it behind the mother's back...call and talk to her and tell her that it is for her benefit and that she needs help...whether she wants to admit/accept it or not.

To me, this is so much more than just lice.

[Heidi the nurse, BSN, RN]

Here is the real problem: That mother doesn't have enough resources and needs help. I personally, would do a social services consultation...not because the mother is willingly neglecting her child, but she may have access to resources she may not realize she can qualify for.

If that kid is having trouble getting lice treated, then what does the mother do when she has a major illness? How does she get to the Pediatrician?

I wouldn't do it behind the mother's back...call and talk to her and tell her that it is for her benefit and that she needs help...whether she wants to admit/accept it or not.

To me, this is so much more than just lice.

I agree a point. I work at several schools where parents don't have resources, but that doesn't mean they don't have insurance. But insurance doesn't pay for head lice treatment.

If by a "social service consult" you mean CPS, I wouldn't go there personally. If the OP has a social worker or counselor in her school I might talk to her, but finding resources for parents is our (school nurses) job too.

[BabyLady, BSN, RN]

I agree a point. I work at several schools where parents don't have resources, but that doesn't mean they don't have insurance. But insurance doesn't pay for head lice treatment.

If by a "social service consult" you mean CPS, I wouldn't go there personally. If the OP has a social worker or counselor in her school I might talk to her, but finding resources for parents is our (school nurses) job too.

I disagree.

If she cannot afford basic over the counter medications, then that means she does not have enough resources. You, as a nurse, cannot get her approved for food stamps, increased cash assistance...that is what CPS referral would do.

CPS does more than just take children away from parents and make their life hard...they also help find resources for sincerely needy individuals by working in conjunction with social services department.

Do you know what government resources the mother is currently receiving?

Unless you do, then I think the mother needs help. How do you know that the child is eating adequately when she gets home? That she has hot water and a clean place to sleep?

You don't...problems start small and then grow. I know tons of mothers on welfare and they all get enough money and food stamps to get through the month IF they budget it...but I see too many of them blowing it on expensive frozen dinners, steaks, pre-packaged salads, etc...and that is why they run into rpoblems at the end of the month.

That little girl needs help. I do not think her mother is being willful neglectful...but it doesn't matter if it is willful or not, if you don't have the resources to provide care, you need help.

[Heidi the nurse, BSN, RN]

I realize that. But I can tell you when I had to treat both of my girls and myself for head lice the total was $60 or so - for one treatment.

We have no information about this mom's ability to pay - heck, she works at a grocery store so probably can the product for 1/2 price (or at least that's the employee discount I got a thousand years ago when I worked at a store). And I can tell you CPS might take a report about head lice (absences) but they won't do anything about it. I have been told this repeatedly.

[BunnyBunnyBSNRN, ASN, BSN]

I disagree.

If she cannot afford basic over the counter medications, then that means she does not have enough resources. You, as a nurse, cannot get her approved for food stamps, increased cash assistance...that is what CPS referral would do.

CPS does more than just take children away from parents and make their life hard...they also help find resources for sincerely needy individuals by working in conjunction with social services department.

Do you know what government resources the mother is currently receiving?

Unless you do, then I think the mother needs help. How do you know that the child is eating adequately when she gets home? That she has hot water and a clean place to sleep?

You don't...problems start small and then grow. I know tons of mothers on welfare and they all get enough money and food stamps to get through the month IF they budget it...but I see too many of them blowing it on expensive frozen dinners, steaks, pre-packaged salads, etc...and that is why they run into rpoblems at the end of the month.

That little girl needs help. I do not think her mother is being willful neglectful...but it doesn't matter if it is willful or not, if you don't have the resources to provide care, you need help.

"like"

[soso]

Prior to becoming a nurse I worked as a medicaid worker. CPS is not the right agency to handle this situation. CPS falls under the Dept of Family Protective Services and is an agency that investigates the abuse and neglect of children. The Dept of Health and Social Services is the agency that provides resources such as food, medical and cash assistance. They also will have listings of community agencies that may be able to help this mother. IF AFTER you have given the mother this information and the child continues to have problems (other than just lice, does she look malnourished, unkempt, does she smell) then a CPS call may be warranted. I doubt the mother is being neglectful. She has tried (she herself has lice too?) and obviously just doesn't have the means.