AAP updates recommendations for managing head lice in school setting
The AAP has issued a revised clinical report on head lice to clarify current protocols for diagnosis and treatment, as well as provide recommendations for managing children with head lice in the school setting.
“It is important to note that head lice are not a health hazard or a sign of poor hygiene and are not responsible for the spread of any disease,” Cynthia D. Devore, MD, FAAP, and colleagues of the AAP’s Council on School Health and Committee on Infectious Diseases wrote in the report. “Despite this knowledge, there is significant stigma resulting from head lice infestations in many developed countries, resulting in children being ostracized from their schools, friends and other social events.”
Regarding exclusion from school, the AAP recommends that healthy children with head lice or nits should not be excluded from school or be permitted to miss school. In fact, it is suggested that ‘no-nit policies’ for return to school be abandoned.
When pediculicide therapy is needed, 1% permethrin (Nix, Insight Pharmaceuticals) or pyrethrins are recommended as first choice options unless resistance has occurred in the community with these products.
“Carefully communicated instructions on the proper use of products are important,” Devore and colleagues wrote. “Because current products are not completely ovicidal, applying the product at least twice, at proper intervals, is indicated if permethrin or pyrethrin products are used or if live lice are seen after prescription therapy per manufacturer’s guidelines.”
While the AAP states that it is not necessary to manually remove nits immediately after treatment to prevent spread, the removal of nits can be considered in the school setting to decrease diagnostic confusion and social stigmatization. The proper training of school personnel involved in the detection of head lice is recommended.
“Head lice screening programs have not proven to have a significant effect over time on the incidence of head lice in the school setting and are not cost-effective,” they wrote. “Parent education programs may be helpful in the management of head lice in the school setting.”Disclosure: The researchers report no relevant financial disclosures.