UGH- Head Lice- But for real, a serious question

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Specializes in Telemetry, Gastroenterology, School Nrs.

I have a little one that is a frequent flyer when it comes to these little pests. I believe I could check everyday and they would be there. Our policy is to only send home if we find live critters. Little one is being sent home again today, which makes the second time in a week and a half. I rechecked the student when they returned to school... I found nits only, and treatment had been carried out, according to the student. We went over the importance of treating and nit-picking and while the drill is familiar, there is absolutely no help at home. We all know this isn't a one-man job.

My question is, what can I do? I have spoken with the parents on NUMEROUS occasions, and child services has been phoned many times (for other issues, but at one time, this one as well).I have even provided treating shampoos. I feel so bad for the child. Short of treating the child myself (which I'm not going to do), I'm at a loss. What are my options at this point? What would you do?

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Specializes in School nursing.

Do you have to keep this child out of school? How old are they? Age is a factor in spread. I deal with MS/HS kids and I have never seen spread in the school (just between siblings and really, even that is rare for me and I work with at risk population).

I guess what I'm saying is the continued sending home impacting this child's education? I'd be talking with my admins on this one to see is an alternative plan needs to be in place for this child that may deviate from the usual guidelines. It sounds like this is one of several issues, and that is so very frustrating. Is there another family member to reach out/connect with that might be able to help with treatment? Can a visual tool be sent home to parents (i.e. video demo) to help with proper technique for removing nits? Is there any language/cultural barrier?

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I know you probably have seen this, but Natroba supposedly has been cleared to not have nits picked out of the hair. Expensive, but maybe the lice are resistant to the products they have been using. Again, it does not allow for the parents not treating the environment, bedding, etc.

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Specializes in school nursing, ortho, trauma.

my district discussed requiring proof of treatment such as a receipt from a box of rid or a letter from lice busters. My argument was that if someone had the stuff on hand they would not be able to produce a receipt and that an empty bottle or box does not necessarily show proof of using the product. That idea never made it out of the talk stage.

Perhaps this parent needs a different approach. They could have a case of lice resistant to the products they are using.

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Specializes in Pediatrics, Community Health, School Health.

That's tough. We have one of those here too and I can't send home for anything, not live or nits. After the third call in two weeks, I finally explained to mom that while it was exhausting and seemed redundant to comb daily, even after they appear to be gone, that combing was really the only way to truly make sure they are taken care of. She finally admitted to only combing the first couple days after treatment and has since stepped it up- no visits in the last two months, fingers crossed...maybe mom really needs to be told to comb consistently. Sorry, I know your hands are tied.

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Specializes in Pediatrics Retired.

Most cases of recurrent head lice are due to applying the second shampoo treatment too soon or not applying the second shampoo. I've heard there are resistant head lice out there but I really think that is the exception. I recommend waiting a full 10 days before the 2nd shampoo to be sure and kill all the lice that have hatched from the initial shampoo (lice will continue to hatch after the initial shampoo but are not capable of reproducing until they are 16/17 days old). If this regimen is followed and there isn't a new exposure to lice you don't even have to nit pick. I'm seeing more prescription treatments that claim a one time treatment is all that is necessary; I'm hopeful but skeptical.

A few years ago our district finally did away with excluding kids from school because of head lice.

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OldDude, how long did it take for the parents to get used to the change in the policy? Do you see more cases, less or about the same now that your district has changed it? I have irate parents calling me up and accusing other students of having them, etc. (very small town)

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Specializes in Pediatrics Retired.

We still have the occasional hysterical parent but the district stands its ground. We inform them the Health Department doesn't consider lice a health hazard and no other health related organization recommends excluding kids from school because of head lice. The hardest group to "break" was the teachers!!!

And no, I haven't seen a change either way in the incidence of head lice; now or even way back when we did classroom head checks...no change.

Just remind the parents their kids walk into a lice free school every Monday morning! Lice are a parent responsibility - not the school's responsibility.

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Will your local public health help out with this? I work for a LPH and we often get lice referral from school nurses for kids with chronic lice.

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Specializes in Telemetry, Gastroenterology, School Nrs.
Do you have to keep this child out of school? How old are they? Age is a factor in spread. I deal with MS/HS kids and I have never seen spread in the school (just between siblings and really, even that is rare for me and I work with at risk population).

This is a MS student, and while there are siblings, this child is the only one with frequent/recurrent episodes.

I guess what I'm saying is the continued sending home impacting this child's education? I'd be talking with my admins on this one to see is an alternative plan needs to be in place for this child that may deviate from the usual guidelines. It sounds like this is one of several issues, and that is so very frustrating. Is there another family member to reach out/connect with that might be able to help with treatment? Can a visual tool be sent home to parents (i.e. video demo) to help with proper technique for removing nits? Is there any language/cultural barrier?

I wish there was another member of the family to reach out to! I feel as though I may get a little further if I could bring someone else into the equation. Unfortunately, that's not a possibility in this instance. The parents are fully aware of how and when to treat, I'm just not sure they carry out their end of the bargain.

I feel so bad for this sweet student.

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Specializes in Telemetry, Gastroenterology, School Nrs.

I'm not sure, MauriceRC, but I am going to check into it! Thank you for the suggestion.

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Specializes in Telemetry, Gastroenterology, School Nrs.
Most cases of recurrent head lice are due to applying the second shampoo treatment too soon or not applying the second shampoo. I've heard there are resistant head lice out there but I really think that is the exception. I recommend waiting a full 10 days before the 2nd shampoo to be sure and kill all the lice that have hatched from the initial shampoo (lice will continue to hatch after the initial shampoo but are not capable of reproducing until they are 16/17 days old). If this regimen is followed and there isn't a new exposure to lice you don't even have to nit pick. I'm seeing more prescription treatments that claim a one time treatment is all that is necessary; I'm hopeful but skeptical.

A few years ago our district finally did away with excluding kids from school because of head lice.

I wish we could get to that point, OldDude! I just (within the last year and a half) got them to agree to get rid of the no-nit policy! It will be a while before I can stop the exclusion totally!

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