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.