Fifteen—that’s how many times Sara Kopp says she treated her 10-year-old daughter for lice in just one school year, according to the Reno Gazette Journal.
Frustrated by the expense and inconvenience—and Washoe County School District policies that she says allow lice to spread at school—Kopp began circulating an online petition in the spring of 2017, the newspaper reported. By early April, the petition—”WCSD Head Lice Policy Must Change!”—had been signed by more than 1,700 people.
By fall, that number ballooned to more than 6,000.
Head lice policies are causing controversy throughout the country, as some districts abandon “no nit” rules that require sending home children who have nits (lice eggs) or live lice in their hair. Increasingly, schools allow children with nits and even live lice to stay (national health organizations recommended the latter policy).
Nevada’s Washoe County School District adopted a “lice allowed” policy more than six years ago, based on recommendations by the American Academy of Pediatrics, the National Association of School Nurses and the Centers for Disease Control and Prevention, which have noted that missing school due to lice is harmful to children academically, socially and emotionally—and that lice do not pose a public health threat.
But public sentiment has not caught up with public health recommendations. Dana Balchunas, Washoe’s director of student health services, says the district’s lice policy has “caught people’s attention every year” largely because many people still mistakenly believe that lice are harmful and easily spread in school settings.
“We get a lot of confusion and questions from a lot of stakeholders—not only parents of kids in school, but also queries from teachers and administrators” Balchunas says.
Despite the fact that those national health recommendations have been in place for more than a decade, policies allowing children with lice to stay in school remain in the minority—in large part due to a combination of ignorance and fear, adds Deborah Pontius, health services coordinator for Pershing County School District in Nevada.
“It’s not about facts, it’s about emotions” Pontius says. “You have to get past that in order to effectively change policy.”
Stigmatized and distracted?
Experts say that only about 10 percent of head lice cases are the result of transmission at school.
The majority of infections can be traced to sleep-overs, childcare and family settings. And contrary to popular belief, head lice aren’t all that contagious—they cannot hop or fly, and don’t survive long on inanimate objects, says Dr. Barbara Frankowski, a member of the American Academy of Pediatrics Council on School Health.
“Lice don’t live for more than 24 hours off of somebody’s head, so you can be pretty sure that by Monday morning, there are no live lice in your school” Frankowski says. Unlike ticks that spread Lyme disease, lice do not transmit illness. “No one has ever been hospitalized or died of head lice” she says.
Sending a child home as soon as lice or nits are discovered can cause stigmatization, Frankowski says.
If a child leaves school early and families receive a “lice letter” later that same day, it’s quite easy for children and families to figure out who the affected child might be. That information often leads to unnecessary exclusion and inaccurate assumptions, Frankowski says.
Students might refuse to play with children suspected of having lice and affected families are often viewed as “dirty” or “unhygienic” by the community, despite the fact that cleanliness has nothing to do with lice.
Besides, the evidence shows that, “if there’s going to be transmission, it’s likely already happened long before lice are found” Pontius adds. “Allowing the child to stay in the classroom until the end of the school day and ride the bus home isn’t going to increase the likelihood of anybody getting lice.”
In Washoe County schools, staff who notice symptoms of head lice in a student must send the child to the health office. Only the nurse and a clinical aide can confirm lice or nits. If head lice are present, the nurse notifies the principal and the child’s parents. The parents can pick up the child or the child can stay in class stay until school ends.
The nurse provides information about lice treatment to the parents, and in most cases, parents begin treatment that same day.
When the child returns to school—which may be the next day—the nurse or aide rechecks for lice. If any are noted and there is no evidence that treatment has been initiated, the case is considered chronic.
The student is allowed to stay in school while health staff reach out to the family to see what additional support might be necessary—including helping parents obtain treatment supplies if there are financial barriers.
Still, policies that allow children with active, inadequately treated cases of lice to remain in school make many people—including schools staff—uncomfortable.
“We’ve seen kids with ukus [head lice] for months” says Corey Rosenlee, head of the Hawaii State Teachers Association. “That creates huge problems in our classrooms and becomes a big distraction for the teacher.”
Rosenlee’s organization has asked the state’s department of education to reconsider its policy of allowing children with lice to remain in school.
“Human nature as it is, the teacher doesn’t want to get ukus in their hair and they don’t want the other students contracting ukus” Rosenlee says. “So now, instead of just trying to work on their lesson plans, teachers are in some ways asked to become a nurse, and that’s asking our teachers to do too much.”
Fine-tuning policies
The American Academy of Pediatrics says that letters notifying families that a case of lice has been discovered may violate privacy laws, cause unnecessary alarm and unintentionally reinforce myths about lice. “Parents think they have a right to know if there’s lice in school, but legally, they don’t” says Pontius, of Pershing schools.
Some schools believe the better approach is to provide parents with general information about lice on a yearly basis.
Douglass Elementary School in Boulder, Colorado, sends families a letter that includes information about the district’s policy (which allows children with lice to stay in the classroom), along with evidence-based information about transmission and treatment.
“I stick to the facts, link to information from the CDC and say, based on this information, this is the protocol we believe is best” says Principal Jonathan Wolfer.
However, not informing school parents about head lice infestation can trigger anger, frustration and public outrage. So, some schools and districts, including Washoe County, continue to notify all families in affected classrooms.
“I have a concern about that part of the policy, but it was such a strong recommendation of our committee—it was unanimous—that we built it into the policy” says Balchunas, the director of student health services.
Since Washoe Country’s transition to a more lenient policy six years ago, fewer children have missed school due to lice. That’s a win, but Balchunas knows the district can’t afford to ignore the voices of concerned community members.
To address stakeholders’ fears, the district will form a committee to review the current policy and the latest research regarding head lice, and to possibly recommend revisions. “We don’t want fear driving policy, but maybe we can do a better job with the PR and education piece” Balchunas says.
Jennifer Fink is a freelance writer based in Wisconsin.
