No Cleaning, No Cry

I am a bit baffled.  Lately, I've been getting comments from people who say they love reading the blog but that they are exhausted by all the cleaning that you have to do when you have head lice.

Which once again makes me wonder if they have really read many posts.

Because if you read the research, you know that extra cleaning doesn't do anything in the fight against head lice.  Lice are not spread by inanimate objects in any significant way.  Lice researcher Ian Burgess has basically said that if a louse falls off your head, it is either dead or dying. Those suckers are designed to stay on the head.  In the 2010 paper, "Indirect Transmission of Head Lice via Inanimate Objects", researchers Deon V. Canyon and Rick Speare conclude: "The control of head lice should focus on the head, not on the environment.  Head lice scholars should focus on how to limit reinfestation rather than providing erroneous control advice...The promotion of inanimate objects that play an epidemiologically important role in head lice dispersal is unsupported by the evidence base..."

What does this mean?  You are not going to get head lice from your couch.  Or your bedding. In this paper, the authors call bedding a "hostile environment" for head lice.  Which means, lice don't want to leave your head because it has the climate (the right temperature) and the sustenance (your blood) that it needs to survive.  Lice will not find this on your cool linen sheets. Or on a hair brush.  Or on a hat.  So don't waste your time cleaning or laundering these things beyond your normal cleaning routine. Excessive cleaning won't help in the fight and it certainly could hurt (exhaustion, burnout, stress, anxiety, extra expenses, etc.)  When I did lice removal in the home, I would sometimes hear, "I didn't have time to do the lice combing what with all of the cleaning and laundry I've had to do." Constant cleaning makes us feel like we are dealing with the problem and being effective, but it is a sad illusion. It is the combing that gets rid of the head lice, not the cleaning.

You are going to get head lice from the head of someone else who has it. Head to head.  And you can't even be 100% certain who that person is, so don't waste your time worrying about that either. Follow the advice of the researchers.  Focus on the head, not on the environment.



 

Head Lice: Do You Ask? Do You Tell?

So you have head lice?  Who have you told?  (Besides me.)  In so many of the emails I receive, people say, “I don’t know what I will do if my (insert close relative or regular acquaintance) found out!!”  In my own home, there is no stigma around having head lice.  My children have never been grossed out about it, even in those times where they have had it.  We respect the bug but we know that it is no match for us. So, talking about head lice with the people we know – friends, family, co-workers, teachers – is a non issue. I would love a world where everyone can be so comfortable with this issue; most of the time and energy wasted on the problem of head lice is due to misinformation and paranoia. Because I am familiar with what head lice are (and are not) I think everyone should just talk about it freely.  

But it isn’t that easy.  I get messages from teenagers who say that their parents would ruin their lives if they found out.  I hear from parents of children who will be cut off from seeing people they love if their head lice is discovered. This issue can bring blaming and fighting and stress.  People’s lives are often restricted or tormented because of the head louse. The tiny louse can bring a huge tension into the home that can have very real consequences. 

So, who have you told?  Who will you tell?  I usually encourage people to tell everyone about their head lice because we will not end the stigma of head lice unless people get comfortable talking about it. And of course, this is still what I think is best.  Ramit Sethi said, “Success in life is directly proportional to the number of awkward conversations you are willing to have.”  I know it can be difficult and embarrassing to start the awkward conversation about head lice.  But once it is started, I believe you will find people are more understanding and helpful than we often expect they will be.

Unless they aren’t. There are things in life that are so much worse than head lice.  Panic. Isolation. Fighting.  Abuse.  If the people in your circle are going to be hurtful to you because of head lice, then I understand why you might want to keep your head lice a secret. It is such a polarizing issue. I have met some people – mostly people who have never had head lice before – who feel that there is some moral obligation for people to disclose if they have head lice.  As if going to work when you have head lice or sending a child to school who has head lice is seen as the most irresponsible act imaginable - the equivalent of going into public with the plague. It is so sad to me that with all the horrible things in this world, people still get ostracized or bullied because of lice.

Because of this, though I would prefer that everyone talk openly about their head lice, I don’t think they should absolutely have to or should be forced to.  Who you talk to about your head lice is your personal choice.  If you discover that your child has head lice, do you have to tell the teacher or the parents of the other children?  Do you have to tell your roommates or your family members?  That is a question you must answer for yourself.    Whatever you do, I hope you can find at least one person who you can confide in about your head lice. I’d say email me, but the reality is, by the time I respond to your email, your louse problem might have already come and gone.  If you can think of one person in your life who is open, caring, non-judgmental, and isn’t grossed out by bugs, maybe that’s the person you should reach out to. Test the waters by asking, “Have you ever had head lice?” Their response, and the panic or lack of panic that goes with it, might inform you about how they might take your news.  And everyone will take the news better if you can demonstrate that you actually know something about this problem and are taking steps to beat it – get informed by reading the posts on this blog and check out the research links.

And if someone discloses to you that they have head lice, follow the golden rule.  Treat others the way you would like to be treated. Kindness is the best lice treatment that there is.

The age old question: "No-Nit" Policies - good or bad?

Tonight I spoke with a mother who is dealing with head lice in her home (and based on what she has done and continues to do, it is my belief that she is most likely effectively dealing with head lice and her family is at no risk to anyone else). However, her out-of-school care centre is considering implementing a "no-nit" policy, a policy that would refuse to admit children if even one nit (louse egg or egg casing) is found on the child's head.

As a lice professional, I understand the desire for such a policy. There is nothing more frustrating than having a child come home from school or daycare with head lice again and again. You feel helpless, because if other children who still have head lice are allowed in the facility, you feel your children will always be at risk, no matter how diligent you are. I completely appreciate this feeling.

But, feelings are not always fact. And the fact is, "no-nit" policies do not reduce the chances of head lice in our child care centres. In fact, they can be harmful to our children. These policies can give us a false sense of security because a child can have an active lice infestation before any nits are noticed. Or, on the other hand, a child may have nits but may not have an active, living case of head lice. Or a case of nits may be misdiagnosed and a child may be sent home for dandruff or psoriasis. (I have seen all of the above). And then there is the impact that such a policy has on the ostracized child and the struggling family. I will never forget the call from the mother who lost her job because she had no child care - her child had had head lice and the daycare centre established a "no-nit" policy.

I have yet to read even one research study that supports the claims of "no-nit" policies. However, it is easy to find numerous studies showing that in reality, these policies can often do more harm than good. My most popular blog post by far is the post about this topic. It is entitled, "Should I keep my child out of school?" I encourage you to read this original post HERE. (And please read the healthy debate that ensues in the comments section.) This is a very sensitive topic for any parent that is dealing with or has ever dealt with this problem and the current Edmonton Public and Catholic school board policies regarding head lice are wide open for interpretation.

That said, some other reputable sources have established very clear positions against "no-nit" polices. Here are just a sample of them:

• Click HERE for the National Association of School Nurses (US) position statement on dealing with head lice in the schools.
  


• Click HERE for the guide book "Staying Healthy in Childcare" published by the Australian government.



• Click HERE to read the abstract from a study by the Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel. The conclusion of this study? "No-nit" policies should be abandoned.



• Click HERE to read the policy paper from Nova Scotia Public Health Services recommending against "no-nit" policies.



• Here's a quote from the policy statement of the Canadian Paediatric Association: "Exclusion from school and daycare due to the detection of the presence of ‘nits’ does not have sound medical rationale." It goes on to state that the American Academy of Pediatrics and the Public Health Medicine Environmental Group in the United Kingdom also discourage ‘no nit’ school policies. Click HERE to read the entire paper.



• HERE's a paper published in the journal Pediatrics stating that "no nit" policies are excessive.



• Time magazine had a 2010 article on the latest research against "no-nit" policies. Read it HERE.
  


• Read the 2007 International Guidelines for Effective Control of Head Louse Infestations HERE. This paper, published in the Journal of Drugs in Dermatology, is a collaboration of researchers from all over the world. Their verdict on "no-nit" policies is as follows: "The no-nit policy, based on the persistence of empty egg cases, is not justified and does more harm than good; therefore, we recommend that it be immediately halted

So, if a "no-nit" policy is not recommended in the fight against head lice, what can a school or day care centre do? It should:

• Learn how to identify an active case of head lice through proper screening. To diagnose an active case, a live louse (bug) must be found. Screening for head lice is best done by wet combing. Check out this blog post on checking for head lice.



• Inform parents and children if lice are found and reassure parents that this is not an issue about hygiene or neglect - head lice are a common fixture in our schools and centres.



• Give parents sound information about what lice are and are not, lice "shampoos" (most are ineffective and none are the cure), excessive house cleaning and laundering (which does nothing and is therefore an absolute waste of time and money), and treatments that work (such as regular wet combing with a proper come and directed blow drying.) Read articles on this blog for more research and information about these techniques.

In my experience, inclusion and knowledge go a lot farther in dealing with this problem then exclusion and misinformation. Instead of creating policies that only look like we are taking things seriously and make us feel like we are doing something in the fight against head lice, let's create policies and protocols that actually do something in the fight against head lice. We will not win this battle if we point fingers, insist upon exhausting and ineffective protocols (like lice "shampoos" and laundering), and continue to shroud this problem in shame. We need to openly share our concerns and frustrations in a way that supports and equips.

Good luck.

Should I Keep My Child Home From School?

This is one of my most popular lice articles - it's an oldey but a goody. I still believe that a child should not have to miss school (or day care) because of head lice, and if you want to know why I feel this way, read this article. Be sure to read the comments section, too.

Head Lice in the Daycare

In a public school, if your child has head lice and the school tells you to keep your child at home, you can probably fight it if you are able to show the school authorities that you are taking reasonable measures to deal with this problem. If your child has head lice and attends a daycare center, dayhome, or out-of-school care facility, that is another story.

Should I keep my child home from school?

I want everyone to take the problem of head lice seriously. Just because I do not endorse the use of pesticidal shampoos, that does not mean that I downplay the seriousness of it. Everyone should give this problem the time and the effort it deserves. That said, should a child with head lice be kept home from school?

School Lice Policies - is "no-nit" the way to go?

Just before taking your child to school, you notice that she has head lice. What do you do? Do you keep her home or find someone who can take care of her for the day? Do you send her to school and hope for the best?

The United States-based National Pediculosis Association recommends that all schools and child-care centres adopt a "No-Nit" Policy. With this policy, children with head-lice are not allowed to return to school until the lice have been removed. The NPA believes we need families to understand that shampooing with pesticides is not enough (and not recommended) and until we manually remove all of the live lice/nits, we will continue the cycle of lice infestation and the cost and suffering that goes with it.

Other organizations, such as the National Association of School Nurses (again, in the U.S.), do not recommend a "No-Nit" Policy. They do not feel that children should miss school over a condition that is not a health risk - especially since we do not have strict policies that keep children home when they have with contagious health conditions, such as colds or bacterial/fungal infections.

I'm torn. Most parents I meet in my business are upset that their schools are seemingly not taking head lice seriously. They are mad at the parents who do not take the time to remove the head-lice from their children and frustrated that they are sending their now nit-free children back into a classroom of infected heads. However, as a working parent, I know it is not easy to drop everything and make arrangements to deal with head lice. If a parent doesn't have the knowledge or resources that they feel they need to deal with the problem, then the head-lice problem will continue. And you can't keep a child out of school for too long.

Also, having nits does not automatically mean that you have lice. There was a study where 63 children were found that had nits but had no bugs. Over time, only 18% developed cases of full-blown head lice. So, with that research, a no-nit policy seems a bit excessive.

My thought is that schools should do regular head checks, through the school nurse, or through volunteers, or through professionals. Schools should equip parents with the best information regarding head-lice. Precautions should be taken to keep coats from touching in the coat room and costumes should be regularly laundered. Students should be encouraged to keep their long hair tied back and all kids should be regularly reminded that they can't share hats or combs. The school should be a place where parents and kids can talk about head-lice without denial or shame. If you are an educator, let's talk about how we can do this.