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.

Will Lice Pick for ??????

Dealing with head lice is one of those activities that society has convinced us costs money. Our local health authority tells families that they must purchase lice "treatments" (pesticides) in order to get rid of these pesky bugs. And yet, people have been dealing with head lice for centuries and somehow were able to fight these parasites without the costly pesticides that we've only had available to us for the last 30 years. People would just pick the lice and nits off of the head, hence the term "nitpicker". You simply don't need to buy lice "shampoos" to deal with this problem.

You also don't need my services. A huge majority of my potential business is turned away because I tell people how to deal with their head lice themselves. Still, sometimes people just want to spend the money for some extra piece of mind.

I've been reading the book The Moneyless Man by Mark Boyle. Mark lived "off the grid", without the use of money, for an entire year. It is a very interesting read with some great tips. With all the "Occupy Wall Street" protests going on in the states and the economic crisis all over the world, I do believe we need to be more conscious about how we use our resources.

In this spirit, I would like to barter my lice services. In other words, if you have a lice problem, I would be willing to exchange my lice removal services for something of value besides money. Here's the fine print:

1. I am willing to barter for items or services that I really need or want. What do I need? Who knows. What do any of us need? Haircuts? Lawn care? Obscure gift cards that you won't use? That ornate 1970's clock that your Aunt Maxine left you in her will that you can't stand? I'm open to interesting ideas. Your item or service should be of a value that is similar to what I charge for lice picking.

2. I am not willing to barter for everybody. Unlike Mark Boyle, I still choose to live in a society that uses money. I don't think that my gas company will continue to heat my home in exchange for lice removal services.

3. This is a limited time offer, available only to those in Edmonton, Alberta or surrounding areas. Sorry to those of you who read my posts in the UAE or Sweden. I'm willing to barter my services until November 30th, 2011.

Let the games begin!

Update: I have discovered, to my surprise, that many people are rather reluctant to barter. However, I now have a lovely dreamcatcher that I didn't have before. I guess I won't be living in a moneyless world any time soon.

Why don't African-American/Canadian children get head lice?

It's true. It is extremely uncommon for African-American children to get head lice. What makes this strange is that Black African children get head lice. What's the difference?

This 2001 article from the University of California explains the reason behind this. North American head lice prefer hair that is round in cross-section - like the hair of Caucasian and Asians. But the hair of African-American's is ovoid (oval or egg-shaped) in cross-section. So they don't like it that much.

The hair of the Black African is also ovoid. But the head lice in Africa have adapted to this shape of hair. Because this is what head lice do. They adapt. In other words, given some time, I'm sure North American head lice will be equal opportunitiy parasites.

Help! I just found out we have head lice!

So you just received the unfortunate news. Maybe from you child's teacher or a friend. Maybe you discovered it yourself. What do you do?

First, take a breath and repeat after me, "It's not life or death. It's just head lice." Remind yourself that head lice are not a health issue. Just because they are icky and itchy, that doesn't mean they are a serious threat. Learn about what head lice are and are not.

Second, take another breath and say, "I can deal with this." Because you can. Think of all the other bigger problems you have dealt with in your life. This is an inconvenience but you will be able to handle this.

Third, forget a lot about what you heard about getting rid of head lice. Don't do ANY extra laundry or house cleaning - I know that most of the available information tells you that you need to bag stuffed toys and wash everything in hot water, but it is simply a waste of your time. In dealing with head lice, most people become burned out - not because of the bugs or the eggs, but because of the cleaning. Just don't do it. (Reverse NIKE psychology.)

Speaking of time wasters (and money wasters), don't put all your trust that chemical head lice treatments or "shampoos" will completely treat your head lice or reduce the time you need to spend combing. All of my business comes from people who first used a treatment (mostly the permethrin based "shampoos" like Nix and R&C). Study after study is showing that in developed nations, our lice have adapted to these pesticides. So, save your money and save your time. Head lice can be dealt with without these treatments.

Fourth, get some inexpensive tools. A great lice comb, a blow dryer, a cheap head lamp, and some cheap hair conditioner are some wonderful tools that you can use again and again with great success.

Fifth, get to work. Read this post about how to remove head lice. Again, lice only thrive on the head so this is the only area you want to spend time on. And don't feel stuck doing all the nit picking in the bathroom - pick a comfortable location. (Look where I nit pick my own children.)
 

Sixth, check everyone else in the household. They may not have it, but you should check to find out.
 

Seventh, get some rest. Have some tea or other comforting drink. Take care of yourself. This is going to be a part of your life for a while. Get informed by reading the various articles on this blog. If you start to panic, go back to step one. You need to ease your mind. This is just an inconvenience. It's part of life. You can do this.

Don't underestimate the little guy.

This past weekend, I had the wonderful pleasure of going into a home of a family with 4 wonderful daughters (and a great mom and dad - you all know who you are!) While looking at heads, our discussions enlightened me in the ways of Manga, jokes, pop songs, and tearful movies. The mom and I also had a brief discussion about fruit flies. We have both recently experienced the "joy" of having fruit flies in the home. What a pain. With fruit flies, you don't know where they came from but you soon find that they are difficult to get rid of. They live off of the food (or food residue) in your home, but sometimes, even if you empty your garbage every night, put away or seal up all leftovers and clean all surfaces thoroughly, you can still have a fruit fly problem and they can resurface in full force once you just happen to leave a dirty dish out for a little while.

If you have had fruit flies before, you know how annoying they can be. Just like head lice. (I think everything reminds me of head lice!) You may think that you have dealt with it because you no longer see the eggs or bugs. However, there is a really good chance that you have missed

Why are head lice such a mystery?

While head lice is an age old problem, in depth research about head lice is a relatively new phenomenon with almost all the scientific research happening within the last 100 years. Unlike some areas of research that have been studied more extensively, we are still discovering new things all the time about head lice. Studies that are just a few years old may already have been disproven. Each year, more comprehensive information is uncovered about head lice transmission and treatment. Why are head lice such a mystery? Here are my thoughts...

Common Sense Myths VS. Radical Research

I love the Internet. More specifically, I love a good search engine. I love being able to find information about almost anything in a matter of seconds via the Internet. Because of these technological advances, the common man has more access to information than ever before in history. We can learn about, and sometimes even seemingly diagnose, illnesses or conditions thanks to Dr. Google.

I think the use of the Internet has really helped in the fight against head lice. Without the Internet, I wouldn’t have access to research and you wouldn’t be reading this blog. That said, I find it sad that while we have new ways to share information, most head lice “experts” are offering up old information about how to deal with head lice. There are some head lice myths that most head lice authorities debunk, such as the myth that head lice can jump (they can’t) or that lice prefer clean hair (they don’t care about your hair, they just want your blood). But there are other head lice myths that are still promoted as fact by most websites and health authorities. Before I talk about them, I ask you, dear reader, to put away your assumptions about head lice; those strongly held believes about bugs or those compulsions that cause you to want to panic. The information I want to share will challenge so much of what you have been told about head lice. Have an open mind and read the research for yourself.

Common Sense Myth #1: To get rid of head lice, you must really clean your house and launder (or store away) your clothes, pillows, stuffed toys, and bedding.

Radical Research: Head lice are not a virus that infests your home or belongings. A louse is a bug that lives on the human head. Research has shown that extensive house cleaning or laundering makes no difference in the fight against head lice.

Why I want you to know this: It breaks my heart to talk to parents (mostly mothers) who are getting only 2-3 hours of sleep every night because they are constantly vacuuming, washing the bedding, bleaching the floors, packing up the toys, etc. I know the panic that head lice can cause in a household and I understand our desire to do everything we can to get rid of it. However, all this vacuuming and laundering is just giving you a false sense of security. It isn’t actually doing anything to get rid of (or prevent) the problem of head lice and it is using up precious energy that you could be using to actually focus on the head and deal with the problem effectively.

Read more about cleaning the Floor and see point #2 below

Common Sense Myth #2: You can get head lice by sharing the hat, brush, seat, or shirt of someone who has head lice and must take great care not to share or touch these items if they have been in contact with someone who has head lice.

Radical Research: Head lice are passed by direct head to head contact. Period. There is no real basis in the common notion that lice are transferred through inanimate objects.

Why I want you to know this: I know that this information goes against what we feel is common sense. This information was even hard for me to swallow – when I first started my journey into head lice removal, I always shared the conventional wisdom that said head lice could be transferred via our hats, brushes, etc. But the research is sound and shows us that time is wasted when we focus on trying to prevent the spread of head lice by controlling our belongings. If we spent less time trying to keep our kid’s jackets from touching other kid’s jackets in school and spent more time just checking for lice on the heads of our children, we would be so much further ahead in the fight.

Read More about transmission via inanimate objects

Common Sense Myth #3: You need to kill the head lice through the use of a pesticidal lice treatment, such as a product containing permethrin, in order to stop the infestation cycle.

Radical Research: Numerous studies have shown that head lice have become resistant to pesticides and are simply not as effective as they once were.

Why I want you to know this: In Edmonton, our health authority and school boards are still telling parents that these pesticidal treatments are the #1 way to deal with the problem of head lice. And yet, ALL of my business comes from people who have first used these treatments. These treatments are costly and rarely work. By putting our faith in these treatments, we are preventing ourselves from actually dealing with the problem. Well meaning, conscientious people, people who have diligently followed the advice of health professionals, are going out in public, assuming that they have solved their head lice problem when they may still be infested and at risk of passing on these parasites. The cycle continues and the problem grows.

Read more about pesticide resistance in head lice and specifically permethrin

Common Sense Myth#4: That chemicals are our only weapon in the fight against head lice.

Radical Research: Wet combing techniques and the use of hot air have been proven effective in the detection and treatment of head lice.

Why I want you to know this: Mechanical removal of head lice is a very accessible and effective technique in the fight against head lice. A proper lice comb is inexpensive in comparison to the cost of lice "shampoos" and can be used repeatedly with each family member. A warm air treatment that has a great success rate in drying out eggs and a substantial success rate in drying out bugs can be carried out with a low-cost hand held hair dryer.

Read more here about wet combing in lice detection

Read more here about wet combing in lice removal

Read more here about the use of hot air

Common Sense Myth #5: Health and school professionals know all about head lice.

Radical Research: Health / school professionals often misdiagnose head lice and recommend unnecessary treatment or call for the removal of children from schools though active cases of head lice may not be present.

Why I want you to know this: Many school boards and childcare centres have "no-nit policies" and yet may be misdiagnosing cases of head lice. Public health and school nurses usually recommend, and some even dictate, the use of chemical treatments. However, they may not know about the most up-to-date research. You can become the expert about your child's head lice. You can detect an active case of head lice through wet combing and with regular follow up, you can deal with this problem without costly treatments. You also have a right to expect your healthy child to stay in or return to school.

Read more about misdiagnosis here.

Conclusion: For every new study that debunks our old myths, many more new web pages come up that reinforce the incorrect stereotypes of having head lice and how to treat it. In fact, there's research about that too. Click here. If you would like to chat about what you've read, leave a comment or email me. Let's stay informed.

Update: Check out these amazing pictures of head lice up close. This is great information about lice anatomy and will help you understand how they live so well on your head.