Presented by: The Glen Ridge Board of Health Head Lice Presented by: The Glen Ridge Board of Health

Contact Information Borough of Glen Ridge (973)748-8400 Glen Ridge Board of Health Donna Lifson, MD – President Jacqueline Yustein – Vice President Sujana Chandrasekhar, MD Elizabeth Baker Deborah Priestman, RN Mike Sherman, PhD Chris Valerian, MD Donna Heinzen, PA

Policies Glen Ridge currently joins many other school districts and day care centers to enforce a “no-nit” policy, requiring that children be excluded from school until they are “nit-free.” Due to scientific evidence and research that shows “no-nit” policies are ineffective in controlling transmission of head lice, the following entities do not support or recommend them: US Centers for Disease Control American Academy of Pediatrics National Association of School Nurses The State of Michigan’s non-exclusionary lice policy is effective in preventing the spread of head lice, while keeping children in school. The Glen Ridge Board of Health therefore recommends that policy changes be made to allow children back to school once treatment has been initiated.

Impact of Exclusion (no-nit) Policies 4-8 million children in the US are over treated each year. 12 to 24 million school days are lost annually. Missed workdays cost by parents having to stay home with their child costs $4-8 billion annually. Psychological impact to child and parent caused by teasing and/or anger directed at infested child/family. Anxiety over head lice often leads to inappropriate treatments that pose health hazards to child and household.

What are head lice? Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood. They cannot jump or fly and do not burrow under the skin. Head lice are not known to spread infectious diseases from person to person and should not be thought of as a medical problem. Head lice are certainly a nuisance, but they are not generally considered a health hazard. They lay up to six eggs per day, attaching the eggs (called nits) to strands of hair close to the scalp. Generally, nits found more than ¼ of an inch from the scalp are dull yellow in color and no longer carry a live louse.

Empty nit case Viable nits Hair spray droplets Dandruff Hair casts

Centers for Disease Control and Prevention (CDC) School Guidelines "No-nit" policies that require children to be free of nits before they can return to school should be discontinued: Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as casings. Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people. Misdiagnosis of nits is very common during nit checks conducted by non medical personnel. The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice. www.cdc.gov/parasites/lice/head/schools.html Updated November 2010

American Academy of Pediatrics Head Lice Guidelines, Aug 2010 Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease. No healthy child should be excluded from or miss school because of head lice, and no-nit policies for return to school should be abandoned. Informed school nurses can help with diagnosis and suggestions about treatment. Because head lice are usually transmitted by head‑to‑head contact, parents should carefully check a child’s head before and after attending a sleepover or camp where children share sleeping quarters. aappolicy.aappublications.org/cgi/content/full/pediatrics;126/2/392

National Association of School Nurses Nit Free Policies in the Management of Pediculosis It is the position of the National Association of School Nurses that nit-free policies disrupt the education process and should not be viewed as an essential strategy in the management of head lice. DESCRIPTION OF ISSUE: Families and school staff expend innumerable hours and resources attempting to eradicate infestations, expending equal efforts on live lice and their nits. RATIONALE: Rarely, if ever causing direct harm, head lice are not known to transmit infectious disease person-to-person. Furthermore, current research does not support the conclusion that enforced exclusion (nit free) policies result in reduced transmission of head lice. Adopted: November, 1999 http://www.nasn.org/positions/nitfree.htm

Michigan School Head Lice Prevention and Control Policy Any student with live lice may remain in school until the end of the school day. Immediate treatment at home is advised. The student will be readmitted to school after treatment and examination. If, upon examination, the school-designated personnel finds no live lice on the child, the child may reenter the school. Any student with nits (farther than ¼” from scalp) should be allowed in school. Parents should remove nits daily and treat if live lice are observed.

Michigan School Head Lice Prevention and Control Policy, cont’d When member of school staff suspects a child has head lice: Restrict child from activities involving close contact (i.e. hugging) or sharing personal items with other children. Notify school/facility administration. Contact parent (verbal communication preferred). Immediate removal of the child is unnecessary. The child can be sent home at the end of the day (allowed to ride school bus home). A letter should be sent home to notify classmate’s parents that a case of head lice is suspected, asking them to check all of their children. Provide information sheet on head lice infestation and treatment. http://www.michigan.gov/documents/Final_Michigan_Head_Lice_Manual_103750_7.pdf

Who recommends No-Nit Policies and exclusion of children from school? National Pediculosis Association – www.headlice.org Sells the LiceMeister™ comb. Mission statement equates lice and nit control to “responsible personal health behaviors” and “a commitment to health and wellness.” Contradicts CDC, AAP, NASN guidelines. No clinical relevance. No data to support the claims.

Conclusions Although Glen Ridge is among many school districts and day care centers that enforce a “no-nit” policy, this policy is not supported by scientific evidence or research. Nor is it supported by: US Centers for Disease Control American Academy of Pediatrics National Association of School Nurses Furthermore, a “no-nit” policy is not in the best interests of the borough’s children, as it can lead to: Excessive school days missed. Unnecessary stigmatization and anxiety. Therefore, the Glen Ridge Board of Health recommends that the Glen Ridge Board of Education change its current policy, to allow children back to school once treatment has been initiated. The Glen Ridge Board of Health proposes the formation of a joint subcommittee between the BOH and BOE to implement a changed policy in order to allow children back to school once treatment has been initiated.