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; PEDIATRICS Volume 135, number 5, May 2015 e1361 by guest on May 3, 2015 pediatrics.aappublications.org Downloaded from
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.
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