Lice Shouldn't Keep Kids From School, Pediatrician Report Says

A recent report on head lice concurs with what a Ridgewood schools health consultant has said for years: Students with head lice should not be kept from class.

A Midland Park pediatrician and health consultant for Ridgewood schools, Dr. Wayne Yankus has advised the district allow students who display evidence of head lice to remain in school.

"Recent reports indicate that lice can be there up to a month prior to being discovered," said Dr. Yankus, a Ridgewood resident. "It doesn't really make a difference sending them home at that point."

This believe has been the prevailing wisdom within the medical community, Dr. Yankus said. That view was affirmed in a July 26, 2010 report issued by the American Academy of Pediatrics in its journal Pediatrics. Ridgewood Superintendent Dr. Daniel Fishbein said the district was "looking into" a change, but no policy shift has been announced.

Dr. Yankus indicated that extreme parental reaction—not actual concerns of spreading diseases—often force schools into conservative policies.  

The report—coauthored by the Council on School Health and the Committee on Infectious Diseases—discouraged schools from zero-tolerance policies against lice for several reasons.

Although head lice affects about 12 million people annually, the report says, "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."

To start, an absolute policy may keep kids from a learning environment for long periods of time.

"Using anecdotal information that described the implementation of a 'zero-tolerance' program at an elementary school, 1 source reported an average of 20 missed days per student dismissed for infestation," the report said.

One measure of detection is the visibility of nits—tiny, empty egg casings. Dr. Yankus said this is the case in Ridgewood. If a nurse detects the nits, a student is immediately sent home. The report cautions against such actions.

"International guidelines established in 2007 for the effective control of head lice infestations stated that no-nit policies are unjust and should be discontinued, because they are based on misinformation rather than objective science," it said.

Dr. Yankus said often the nits are confused with lice themselves, but in fact are harmless. Because lice are very small (between 2 and 3 millimeters in length) and move quickly, it is difficult for people who aren't medical professionals to detect them. 

To treat lice Dr. Yankus and the American Academy of Pediatrics (a body that he is currently running for its presidency) say immediate action can quickly remedy the situation. Pediculicides with 1 percent permethrin are the primary treatment recommended for head lice and are available over the counter.

The report recommends, "If a child is diagnosed with head lice, confidentiality must be maintained. The child's parent or guardian should be notified that day by telephone or by having a note sent home with the child at the end of the school day stating that prompt, proper treatment of this condition is in the best interest of the child and his or her classmate."

Although Dr. Yankus agrees with that statement, he said fear of inaction from parents or guardians is what prompts schools to enact rigid policies.

"If there's repeat offenders school nurses have to lay down the law," he said. If a parent doesn't treat his or her child, then school's "must wait until lice is officially gone."

In the past and following the report, Dr. Yankus has recommended the district abandon its no nits policy

"Schools without 'no nit' policies sometimes weakly enforce them because parents became hysterical. They're almost less worried about flu than common head lice."

Dr. Yankus thinks Ridgewood should change.

"Yes, we knew [this report] was coming. Yes, there's an hysteria about it with parents. But the bottom line is if parents follow directions... you can generally get rid of lice and eggs," he said.

If the schools do keep the no nits policy, Dr. Yankus encourages communication between the schools and parents. Additionally, he recommends kids not share headwear and properly store hats during the school year.