In regard to school management, the new guidance reiterates its assertion that children should not be excluded from school or school events because of lice, and that screening for nits is not a good indicator of infestation. In fact, such screenings have been shown to have little effect on the incidence of head lice and are not cost effective. For example, the AAP highlights a study in which, of 1729 children screened for head lice, only 31% of the 91 children with nits had an active live lice infestation. Another 18% with nits developed an infestation within 2 weeks of observation.
“Because of the lack of evidence of efficacy, routine classroom or schoolwide screening should be discouraged,” the AAP says. “Although children with at least 5 nits within 1 cm of the scalp were significantly more likely to develop an infestation than were those with fewer nits (32% vs 7%), only one- third of the children at higher risk converted to having an active infestation. School exclusion of children with nits alone would have resulted in many of these children missing school unnecessarily.”
Additionally, says the AAP, lice infestations have low contagion in classrooms. Between that and the fact that children who are diagnosed have likely been infested a month or more by the time of diagnosis, students diagnosed with a lice infestation should remain in class but close head contact with others should be discouraged. Alerting an entire classroom of parents also should be questioned, the AAP says, citing sentiments from experts that “because of the relatively high prevalence of head lice in young school-aged children, it may make more sense to alert parents only if a high percentage of children in a classroom are infested.”
“No-nit” policies that exclude children from school activities until all nits are removed also should be abandoned according to many health professionals, the report says. “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,” the report states. “The American Academy of Pediatrics and the National Association of School Nurses discourage no-nit policies that exclude children from school. However, nit removal may decrease diagnostic confusion, decrease the possibility of unnecessary retreatment, and help to decrease the small risk of self-reinfestation and social stigmatization.”