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.

[bergren]

Thank you for advocating for this child and family and for your wise principal who is balancing school policy and the realities of life for your students and families. She understands that we are dealing with people's lives and employment, and for a family this needy, one too many call form the school nurse will result in that parent being fired.

Check with the principal and see if the district has a social worker who will work with needy families.

I applaud all who responded above with compassion and on the state of best practices for lice and nits.

[bergren]

Below is a citation from an article 14 years ago in the Journal of School Nursing about how one school approached lice by providing hair care and delousing. This article predates JOSN's electronic journal articles. It is a beautifully written article.

Grabeel, J. (1997). Rapunzel¿s place. Journal of School Nursing, 13(3), 34-36. An innovative approach to personal hygiene education and intervention and pediculosis management in an elementary school. The three-phase project consisted of a hand-washing program, distribution of personal hygiene packets, pediculosis education, and intervention which culminated in the establishment of a school-based beauty salon

[tictac]

Thank you for all of your responses. Unfortunately, in my district, we are required to exclude children with live lice. I can only imagine the uproar from the teachers if I said these kids didn't need to go home! This child's teacher has sent her to me 3 more times since I last wrote, but thankfully, no live ones were present. She does still have nits though. She says mom has been combing her hair with the special comb every night and has washed all of her sheets, stuffed animals, etc. Sounds like she is really trying her best.

Next year, I am definitely using some of my budget to purchase a few kits for cases such as this. This being my first year, I had no idea what to expect. Thanks again for your input. You guys are awesome!