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.

Myth Busters: This time, with research!

Here's a link to a blog post that challenges conventional wisdom with radical research. Don't believe everything your neighbour's grandmother's friend's daughter's nephew's teacher tells you about head lice. Read up on the little suckers for yourself.

Don't wait. Do something.

With head lice, as with most things, knowledge is better than ignorance. However, sometimes, we are reluctant to act on a problem because we don't feel that we have the right tools or expertise. Don't feel that way with head lice. If your loved one has head lice, there are only a handful of things you can do to make this problem worse:

1. Rub your head on their head. Share the love and the bugs.
2. Use toxic or unsafe treatments or methods to deal with head lice.
3. Scratch the bites until infection develops.
4. Do nothing.

Most people can easily avoid the first three actions. But it is surprising how many people do the fourth action - or should I say, inaction. They do nothing about head lice because they feel ill equipped to deal with it. Read this blog post about how even doing the little you can do with what you have can go a long way in dealing with head lice.

Myth Busters: Lice Edition

In a world where we have more research information then ever before, it amazes me that certain myths still prevail about head lice. You may have even heard some of them.

First, there are the old myths which most people now recognize as untrue:

Myth 1: Lice can jump or fly.
Nope. They are not built for it. They also cannot climb up your leg if they have fallen on the floor. On the hair, watch out - they have a need for speed and can move quickly. Off of the scalp, they can barely crawl.

Myth #2: Lice are microscopic. Not true. Lice do not spread like viruses. Lice can be seen with the naked eye. If you can see the period at the end of this sentence, you can see a newly hatched louse or a nit (egg). Adult lice can grow to be the size of a large sesame seed. Nymphs (immature lice) can be as small as a speck of pepper (at this stage, they will be red.) So, lice and nits are not microscopic, but they can still be hard to see and easy to miss. When on the hunt for head lice, ensure that you have good light and patience.

Myth #3: People can get head lice from, or give it to, their pets.
No, pediculosis capitis is a human parasite. Dogs and cats have their own species-specific lice.

Myth #4: People get head lice due to poor hygiene.
Body lice, yes. Head lice, no. The next myth that circulates after this one is that lice actually prefer clean hair, but really, lice just like a warm human scalp. Clean or dirty, it doesn't matter.

And now some other myths that you might not be so familiar with:

Myth #5: You need to treat your head lice with lice "shampoos" or treatments.
When I tell people that I deal with head lice without using any specialized lice treatments, they sometimes look at me as if I have a third eye. Not only do you not need special lice treatments to deal with this problem, studies are showing that many of these treatments, especially those with permethrin shampoos, are ineffective as lice are adapting to these pesticides. It is my opinion that the use of these shampoos is actually increasing the problem as in trusting these treatments, we are not actually doing what we need to do to get rid of the head lice and the problem just grows and grows.

Myth #6: You need to do extensive cleaning, wash bedding, and put away stuffed animals to keep from being re-infested with head lice.
Extra house cleaning and so-called protective measures do nothing in the fight against head lice. Really. When I tell this to parents, most are in shock and half are in disbelief. Usually because they just took three days off work to clean their house from top to bottom and are exhausted. But the research is clear - head lice are spread by head to head contact. You don't get head lice from the love seat. They only thrive on the scalp. All energy should be spent on removing lice from the head.

Myth #7: All medical professionals know best.
Not all. Some know nothing about head lice. I've seen too many people misdiagnosed with head lice when they didn't have it or dry scalp when they did. I trust community health nurses that actually deal with lice removal on a regular basis over doctors who only know what they have read in books. I trust medical professionals who do research in the are of head lice over school nurses that hand out pamphlets that say "You must use a permethrin based shampoo." I am not a medical professional and neither are any others in the lice removal business. We are more like housekeepers, doing a cleaning job that you could do for yourself but don't want to or can't do. And just as a housekeeper knows dirt, we know lice.

Myth #8: Feelings never lie.
In most circumstances, our feelings and anxieties serve a purpose. They protect us and move us to action. However, there are some of you who still let the panic and phantom itching take a hold of you at the mention of the head lice. Maybe you are dealing with head lice and continue to drain your energy in cleaning marathons or are pouring every kind of expensive lice concoction or unproven home remedy on the scalps of everyone in your household. Your feelings tell you that you need to go crazy to deal with this problem. But your feelings are wrong. I know lice give you the creeps but you don't have to go nuts, no matter what your gut says.

Get information and let your head lead you on this one.