Final Head Lice Questions: What If A Kid 'Flunks' Inspection, And More

This is our third and final set of questions on head lice behavior (that is, human behavior when dealing with head lice, not the behavior of the bugs themselves.) The first set is here, and includes an introduction of our experts. The second set is here, and we wrap it all up in an overarching post here.

9. Children talk among themselves, and my child tells me that a classmate "still has lice." What do I do?

Mimi Stamer, MSNO:
If you have a relationship with that other child's parent, you may speak to him/her about what your child has shared and offer to help or advise. You may also share the concern with the school nurse and she will follow up appropriately. Lots of children hear, see, or say things about lice that are not accurate so you don't want to panic due to what your child says. You may stress to your child the importance of their personal lice prevention behavior- no sharing of head accessories, hats, head-head contact, keeping hair pulled up and back, etc.

Richard Pollack, PhD, IdentifyUS, LLC:
Smile and embrace the opportunity to educate yourself and your child about the fascinating biology but insignificant health concerns associated with head lice.  Similarly, exploit this chance to discuss the acceptance of others and of compassion.

Helen Hadley, The Nit-Picker, Inc.
I have heard of parents calling the school nurse anonymously and letting them know about a known case of head lice in the school. The nurse will take it from there in whatever consider appropriate.

(The following questions come from a friend in a shi-shi New York suburb:)

10. My daughter has lice and feels like she's being shunned at school. We've talked, and she knows that's not right, but she's feeling bruised. I want to hug her and snuggle with her in her bed....but I don't want lice. What should I do?

Mimi Stamer, MSNO:
You must remember that lice is not a life-threatening contagious disease... so if your child needs a hug and a snuggle from her mom, you need to be there for her. You may protect yourself by treating your child's lice per the directions on the shampoo, picking out nits daily, cleaning her combs/brushes, bed linen; I would suggest you clip your hair up, and snuggle...Comb your hair afterward to remove any live lice. Lice don't fly or jump!

Deborah Altschuler, NPA:
Fear to hug one’s child because of head lice may contribute to more fear and chaos.   Parents need to step up and show children that while this may disconcerting, it need not be a crisis.  Informed parents are more likely to be confident, calm and careful about how they handle the situation.  Children also need to know and understand their part — that they will need to cooperate with special time and attention to help mom and dad remove all the lice and nits from their hair.  But it is good to avoid burdening them with our own fears, understandable as they may be.
This said, feeling shunned may still be a reality for some children who experience head lice. People who are afraid will taunt others they perceive to be vulnerable. This is a much bigger issue than pediculosis!  Too often, people are afraid because there has been no collective will to teach them not just about head lice but also about being kind and sensitive to others.  Pediculosis can be a learning experience for everyone.  Explain that sometimes there aren’t perfect answers but that you will always do the best you can to help your daughter.  Comb her thoroughly with a quality lice and nit removal comb and assure her that all the lice and nits have been removed from her hair.  Even if it takes several sittings, she will know she is getting the attention she needs. Always be aware that parents set the behavior standard on pediculosis.  This is a great opportunity to teach your child healthy behaviors.

Richard Pollack, PhD, IdentifyUS
Get over your fears, and do so quickly.  Acting as if your daughter has a highly contagious and fatal condition (head lice are neither) serves no purpose but to harm yourself, your daughter, and your relationship. Your child deserves hugs, whether or not she has lice.  What would you do if she actually had something serious?

Helen Hadley, The Nit-Picker, Inc.:
Comb your child’s hair for 15 to 20 minutes with a fine-toothed comb. If nothing comes out, give your child a hug.

11. We love the school nurse, but she's completely uninterested in this topic. The kids toss their sweatshirts in a pile at gym, and it makes my skin crawl. She says "It's the parents' responsibility" and on one level I agree, but the school has a role here, too. What should I do?

Mimi Stamer, MSNO
This is confusing to hear as most school nurses are totally interested and involved with lice prevention and management. It is a team responsibility — parents and schools. As for the pile of coats, I would talk with the teacher, principal, or program director about other options for the children to store their outerwear. You may want to set up a meeting with the principal and school nurse to discuss together how lice may be managed and how parents may help the schools, too. It is the school nurse's role to check children's heads in schools and communicate with parents but it is the parents' role to check their own children's heads and treat lice as necessary, and the principal's role to support a healthy environment for all.

Deborah Altschuler, NPA
Nurses have many challenges and multiple responsibilities in the course of the day. It is unfair to assume that they do not take this issue seriously.  Sometimes the school nurse may be responding to what is perceived as a judgmental attitude.   School nurses will appreciate a parent population that makes head lice awareness important and does its best to send their children into the classroom lice and nit free.  Read and share NPA’s No Nit Policy. It’s a roadmap for proactive strategies that are all about setting the highest possible standards for children, parents and the entire community.

Richard Pollack, PhD, Identify Us
The school nurse's responsibility is to focus on real health issues, not minor maladies or annoyances.  She likely has many hundreds of kids to oversee every day. Some kids need first aid, others require help monitoring physiological parameters or dispensing medications.  Asking her to spend time on something as trivial as head lice is a poor use of her time.  It may even violate terms of her contract or license.  Head lice infest children, not school buildings.  The school nurse's responsibility on louse issues should be limited to helping to educate parents on how to ensure a child's condition is properly characterized and managed.

Helen Hadley, The Nit-Picker
I have read that across the country schools have changed their lice policy in recent years—the No-Nit policy has virtually disappeared. Many, or most, schools now consider head lice to be a family’s issue and not the school's responsibility. The No Child Left Behind Act states that if a school meets certain criteria it qualifies for additional federal funding. High attendance rates and high test scores are among the criteria cited, each of which is adversely affected by absenteeism due to head lice. I know of many families that challenge their school’s new nit policy but have not heard of a parent who succeeded in effecting change within the public schools.
The issue of tossed sweatshirts is an easier topic to address. There are schools in the Boston area that have allowed the use of a draw string bag for each child’s hat and coat that hang from coat hooks. However, I only know of cases like this in which PTC funds have paid for the bags. I have also heard from teachers that in theory it sounds good but in reality the children are finding it too time consuming to bother with and coats end up on the floor as before

12. The kids are telling each other that lice are being passed (at the movie theater, at x restaurant). I don't know that to be true, and I don't know it not to be true. What should I do?

Mimi Stamer, MSNO:
Lice need the human scalp to live so they can not be passed on by movie theatre or restaurant chairs etc. It is the head of a person with lice that passes on lice.

Deborah Altschuler, NPA:
Screen your children for lice and nits before and after they go to the movie theater.  This gives you control of the situation no matter what.

Richard Pollack, PhD:
Rumors spread faster than can any natural infection or infestation.  Parents should educate themselves so they can sort the wheat from the chaff of misinformation, then do their best to inform their own kids as to the facts. Kids have a surprising capacity to learn about rumors as well as the damage that can be wrought by spreading them.

Helen Hadley, The Nit-Picker, Inc:
We take lots of risks each day that begin with stepping out of bed in the morning. Bringing in the mail during an ice storm could potentially result in a fall that could crack your head open—or worse. But we don’t stop to consider whether bringing in the mail is worth the risk.
In my opinion, the potential of getting lice from a movie theater seat, a booth in a restaurant or an airplane seat does not pose a high enough risk to stop a person from going to the movies, a restaurant or boarding an airplane. If a person is concerned about the potential of getting head lice from any of these places, they can always check their child’s head for lice and nits when they get home. If you do decide to check for nits, do it during daylight hours, if possible, and check just the first inch of hair, primarily around the outer perimeter of the hairline. The hairs around the ears and across the back of the neck are the most likely spots to find them. Combing with a fine toothed comb is an effective way of finding and removing nits from these areas as well.

13. My school's PTA has paid for lice-pickers to come and examine each kid. One kid flunked the test and had to sit on a bench alone waiting for her dad to come pick her up. What should I do?

Mimi Stamer, MSNO:
No nit policies and mass screenings are not recommended as effective by medical and public health experts. Having PTA sponsoring lice pickers sounds inappropriate as well, violating children's rights. The school nurse should check children's heads if necessary and maintain the privacy and respect for the child if live lice are found. Children do NOT need to be immediately excluded from school if they are noted to have lice. Parents are notified and treatment is to be initated as soon as possible.
Helen Hadley, The Nit-Picker, Inc:

Deborah Altschule, NPA:
Oh my!  Children don’t “flunk” because they have head lice.  This is an unfortunate judgment.   Encourage the school administrators to employ a more sensitive approach.  Screenings can take place before the end of the school day when parents will be coming to pick up their children anyway.  The key is to let parents know about such screenings in advance.  This is the respectful and responsible thing to do for parents and and their children. This will hopefully encourage them to screen their children at home before sending them to school that day.

Richard Pollack, PhD, IdentifyUS:
Service providers who 'pick nits' or comb or treat for lice should be welcome to offer their wares in the marketplace, but not in the school.  Provide scientifically and medically relevant resources to PTA members, and explain that many common actions and policies are based upon long-standing misinformation and fear. Explain to the PTA and the school administrators that their screening and exclusion policies are inconsistent with modern accepted medical practices.  Continuing to pursue these practices unnecessarily punishes the child and her parents, and risks inciting legal action against the school.

Helen Hadley, The Nit-Picker, Inc:
You could sit down next to the child and say, “Let’s wait here together until your dad comes”. Later you could point out to the nurse that it seemed unfair and unnecessary to you to do this to a child and you could remind the nurse that medical issues are supposed to be confidential—even for children.

14. My daughter's best friend's mom is totally not in denial. She has bought buckets of the shampoo, but I believe the shampoo alone doesn't work. What do I do?

Mimi Stamer, MSNO:
Your friend's mother needs education about treatment. Buckets of ovicidal shampoo is dangerous for the child. Treatment usually involves two shampoos spaced a week apart and the daily combing and nit picking for as long as necessary, which is usually a few weeks.

Deborah Altschuler, NPA:
To the best of our knowledge there is no such thing as a chemical that will do it all.  This is one of the many reasons the National Pediculosis Associatioin is adamant about the importance of early detection and combing out all of the lice and nits.  Children are vulnerable to the risks of chemicals designed to kill lice.   Many parents have no idea that lice shampoos are pesticides.  There is an old medical proverb that fits the seemingly endless list of products on the market for children with head lice — "When there are a lot of treatments for a disease you can be sure there's no cure."   Do what the researchers do to collect data.  Use a quality comb (NPA recommends the LiceMeister comb) and remove all the lice and nits.  When they are all out of your hair — you don't have them anymore!!

Richard Pollack, PhD, IdentifyUS:
Offer guidance and compassion.  Make sure the mom understands that treatments are warranted solely if live (crawling) lice are found on the scalp hair.  Treating for nits is unwarranted.  Next, make sure the products have been used properly, and that others in the home have been checked to make sure they're not harboring their own populations of head lice.  If live lice persist, the mom should converse with the family's pediatrician to weigh the options, including the use of available prescription pediculicides.

Helen Hadley, The Nit-Picker, Inc:
If the person is a close friend you could challenge her assumptions about the value of and the risk inherent in using chemical shampoos, especially by the bucket-load. If the person is not a close friend, I wouldn’t consider it to be my business to do or say anything unless I was asked or unless I was avoiding including her child in my child’s activities. In that case I would let them know my concern about their child and your own being together because of the head lice issue. I would hope the other parent would assure you that their child has been treated or is being treated regularly. This would be the point at which you might challenge their assumptions about the use of chemical products for the treatment of head lice.

Tomorrow: Ten most comforting things to say to a parent dealing with head lice (suggest yours!)

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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