Management on the day of diagnosis because a child

Management on the Day of Diagnosis
Because a child with an active head
lice infestation likely has had the
infestation for 1 month or more by
the time it is discovered and poses
little risk to others from the
infestation, he or she should remain
in class, but be discouraged from
close direct head contact with others.
If head lice is diagnosed in a child,
con fi dentiality is important. The
child ’ s parent or guardian may be
noti fi ed that day by telephone or by
having a note sent home with the
child at the end of the school day
stating that prompt, proper treatment
of this condition is in the best interest
of the child and his or her classmates.
Common sense and calm should
prevail within a school when deciding
how “ contagious ” an individual child
may be (a child with hundreds versus
a child with 2 live lice). It may be
prudent to check other children who
are symptomatic or who were most
likely to have had direct head-to-head
contact with the infested child. Some
experts argue 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. Other
experts feel strongly that these “ alert
letters ” violate privacy laws, cause
unnecessary public alarm, and
reinforce the notion that a head lice
infestation indicates a failure on the
school ’ s part rather than
a community problem.
85
However,
studies examining the ef fi cacy of alert
letters are not available;
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consequently, some schools choose to
design guidelines that they believe
best meet the needs of their student
population, understanding that
although a head lice infestation may
not pose a public health risk, it
may create a public relations dilemma
for a school.
Criteria for Return to School
A child should not be restricted from
school attendance because of lice,
because head lice have low contagion
within classrooms. 79 “ No-nit ”
policies that exclude children until
all nits are removed may violate
a child ’ s civil liberties and are best
addressed with legal counsel for
schools. However, most health care
professionals who care for children
agree that no-nit policies should
be abandoned.
85
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.
86
The American
Academy of Pediatrics and the
National Association of School
Nurses
87
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.