A Parent’s Guide to 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

What are head lice? Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood. Head lice cannot jump or fly and do not burrow under the skin. Head lice are the most common type of lice and live mainly on the scalp, at the base of the neck, and in the eyebrows and eyelashes. They lay up to six eggs per day, attaching the eggs (called nits) to strands of hair close to the scalp.

Life Cycle Nymph hatching Nymphs Female & Male Louse Nit

What are the symptoms of head lice? Head lice are not known to spread infectious diseases and should not be thought of as a medical problem. A person who has head lice may feel itching, but children often show no symptoms. Persistent scratching can lead to skin irritation or infection. Head lice are certainly a nuisance, but they are not generally considered a health hazard.

How are head lice spread? People or objects that are infested can transmit the live lice or their eggs (nits) through: Direct head to head contact. Indirectly by shared combs, brushes, hats, pillowcases. Head lice cannot jump or crawl distances. Head lice do not survive on pets or animals. Head lice need body temperature conditions to live. Survival time away from the human head is short (few hours).

How are head lice diagnosed? Nits may be present two to three weeks before itching begins. The most accurate way to diagnose head lice is to find a living adult louse. However, adult head lice are rarely seen because they are fast and hide well. Identification is usually made by detecting nits attached to the hair near the scalp. Nits are tiny, white or grey oval specks that do not come off of the hair easily like a speck of dandruff would. Nits are most noticeable on the back of the neck, behind the ears near the hairline and at the very base of the hair shaft. Nits found within ¼ of an inch from the scalp usually mean the nits are alive and treatment is needed. Generally, nits found more than ¼ of an inch from the scalp are dull yellow in color and no longer carry a live louse. Called casings, they can be manually removed with a fine toothed comb.

Empty nit case Viable nits Hair spray droplets Dandruff Hair casts

How are head lice treated? Medicated Shampoo 80 to 95% effective Mechanical Removal 38% effective Alternative methods not proven Environmental controls Measures you can take at home in conjunction with treatment.

Medicated Shampoo (pediculicide) Shampoo the hair with a medicated shampoo or cream rinse containing one of the following chemicals: pyrethrin or permethrin. These OTC shampoos used for treatment should be used with care. Read and follow the package or label instructions very carefully. After shampooing, hair should be combed with a fine toothed comb. Removal of all nits after treatment is not necessary to prevent further spread. If nits or newly hatched lice are still present after 10 days, an additional treatment may be necessary.

Mechanical Removal Effective as sole treatment in 38% cases. Use fine-toothed comb. May take several hours each day. Combing should be repeated daily until no lice are seen, then continued for 3 weeks.

Alternative Methods (not proven) No FDA standards or licenses of approval. Kill adults and nymphs, but not eggs (nits). Must be combined with combing. Suffocants Petroleum jelly, mayonnaise, oil-based products. Enzyme products Claim to dissolve/soften the adhesive glue. attaching the nit to the hair shaft.

Head lice do not survive for long periods of time off of the scalp. Follow up at Home Head lice do not survive for long periods of time off of the scalp. The following steps should be taken to avoid recurrence of lice that have recently fallen off of the head of an affected person. Check every family member for lice prior to cleaning the home environment and treat if necessary. Wash personal items: hats, pillow cases, bed linens, towels, soft/stuffed animals, etc. in the washing machine in hot (130°F) water and dry in a machine dryer on the hot cycle for 30 minutes. Any items that cannot be laundered should be sealed in a plastic bag and stored for 24 hours in sub-freezing temp, or at room temp for 2 weeks to kill lice on these objects. Thoroughly vacuum large items such as bare mattresses, box springs, carpets, floors, hard toys, coat collars, couches, chairs, car upholstery and children’s car seats.

Follow up at Home, cont’d. Wash (128°F for 5 minutes) or boil combs, brushes and hair accessories (barrettes, elastics, headbands). Alternately, combs and brushes can be washed with one of the lice-killing shampoos or by soaking in mild bleach solution (tablespoon bleach per quart cool water), rubbing alcohol or Lysol for one hour, then scrub with soap and hot water . Disinfect helmets with mild bleach solution. Do not spray surfaces with insecticides and do not use insecticide sprays to treat people. These chemicals can be harmful to both people and pets.

Family Education Make head checks part of routine family hygiene. Check children’s heads during an outbreak or if you notice symptoms. The earlier lice are found, the easier they are to treat. Teach children not to share clothing, hats, brushes, or combs with other children. Teach children to hang coats and other personal belongings separately if possible and/or to tuck hats and scarves into their sleeve. Education of schools, families and professionals is important in changing our culture’s emotional response to head lice.

Impact of Exclusion (no-nit) Policies by School Districts 4-8 million children in the US are over treated each year. 12 to 24 million school days are lost annually. Missed workdays 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 hazard to child and household.

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 nonmedical 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.

Local Policies Glen Ridge joins many 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 - CDC American Academy of Pediatrics - AAP National Association of School Nurses - NASP The Glen Ridge Board of Health therefore recommends that policy changes be made to allow children back to school once treatment has been initiated.

Where can I find more information? US Centers for Disease Control and Prevention - www.cdc.gov/ncidod/dpd/parasites/lice/default.htm NJ Department of Health and Senior Services http://www.state.nj.us/health/cd/documents/f_headlice.pdf American Academy of Pediatrics http://www.aap.org/ National Association of School Nurses http://www.nasn.org/Home Michigan School Head Lice Prevention and Control Policy http://www.michigan.gov/documents/Final_Michigan_Head_Lice_Manual_103750_7.pdf