The National Pediculosis Association, recommends its No Nit Policy as the public health standard intended to keep children lice free, nit free, and in school.
Pediculosis represents one of the most common communicable childhood diseases and whether or not we understand how this has evolved, it is important to acknowledge head lice as a problem when raising or caring for children.
NPA’s No Nit PolicyThe Spirit of the NPA’s No Nit Policy is to minimize head lice infestations as a public health problem and to keep children in school lice and nit free.
Establishing Consistent Guidelines
The NPA’s No Nit Policy encourages each family to do its part at home with routine screening, early detection, accurate identification and thorough removal of lice and nits. Establishing consistent guidelines and educating the public about procedures in advance of outbreaks helps minimize inappropriate responses.
Early intervention provides the needed assurance for those who have successfully eliminated an infestation that everything possible is being done to prevent new outbreaks when children return to groups where close contact is inevitable. Repeated exposures to pesticidal products put children at risk. Parents need to be informed that chemical treatments may also be dangerous for children with certain pre-existing medical conditions and/or medication regimens. Families with pregnant or nursing mothers should be given advance notice that early detection with manual removal of lice and nits can serve as a safe alternative to pesticidal lice treatment products.
Why The Controversy?
Opponents of No Nit Policies say that “overzealous” enforcement can lead to inappropriate exclusion of children with residual nits, but whose infestation has otherwise been “treated.” Those who judge enforcement to be “overzealous” may not consider the broader public health values and preferences of the community. Few who oppose the No Nit Policies would accept infestations for themselves or for their own children.
Without the No Nit Policy, communities are left with a hit-or-miss approach. Indifference about adopting a standardized management protocol permeates the attitudes of health professionals at every level. This in turn gives way to a maze of conflicting opinions and directives that are counterproductive. Public health policies for head lice cannot be based solely on the use of chemical remedies.
The Food and Drug Administration recommends repeating chemical treatments in 7-10 days because none of the available treatment products are 100% effective against lice eggs and that remaining viable nits will hatch lice. Unfortunately, the FDA’s directive does not take into consideration the endemic nature of head lice. Children being managed in this manner can infest others or become reinfested in the interim. Mechanical removal of head lice and nits is less noxious and more likely to be successful than repeated chemical treatments.
Strategies That Will Make The No Nit Policy Succeed
Emphasize Prevention
Promptly inform all parents of a case of head lice. Here is a sample letter to parents:
“A case of head lice has been reported in your child’s group. Head lice continue to be one of the most prevalent communicable childhood diseases among children, and outbreaks are possible whenever and wherever children gather. Screen your child regularly and notify us immediately if head lice or their nits (lice eggs) are detected. (We welcome the opportunity to teach those of you who do not know how to check your child for head lice). Working together helps protect all of the children, including your own. Thank you for your cooperation.”
Head Lice Aren’t All Bad News
Head lice provide an early opportunity to teach children responsible personal health behaviors. Children can learn communicable disease prevention concepts in a meaningful way and learn to take responsibility for their actions. It is vital that we build consistent and positive public health messages for children who mature into a world of behavior-related health threats including alcohol, drugs and AIDS.
Administrative Advantages of the No Nit Policy
Having the No Nit Policy in place makes the task of the staff of the school, camp, or child care facility more realistic and less subjective. If nits are present upon screening or re-screening, the child is dismissed for follow-up. As an administrative policy, it helps parents understand and assume their responsibility for head lice control. Families are encouraged to respond by carrying out the most effective prevention measures at all times and the safest most thorough control measures possible. For the child whose family is unable, for whatever reason, to comply with the policy, the “system” must go the extra mile to ensure the child is able to return to their group lice and nit free. The reward is an environment of mutual assurance that the child enters a group setting that supports a head lice control program.
Medical and Social Advantages of the No Nit Policy
Nurses cited non-removal of nits as one of the primary causes of treatment failure. With nit removal absent from school policy, children with hatching nits are readmitted to the group setting. Still there are many, perhaps more distant from the front lines, who dispute the value of removing nits. This opposition is based on a reliance on chemical agents rather than a preventive approach, a belief in second and even third pesticide treatments as “mop-up” operations and the notion that pediculosis is not a significant disease.
In 1990, the NPA published a warning to the public that resistant strains of head lice were inevitable based on the way the products were being vigorously marketed and inappropriately used. Again in 1995, the NPA notified leading manufacturers of both permethrin and pyrethrin-based pediculicides that the NPA was receiving increased numbers of treatment failure reports from parents and health professionals alike, indicating possible lice resistance to some of these products.
In 1996, the NPA sponsored independent scientific evaluations of head lice sensitivity which documented permethrin-resistant head lice from children in Massachusetts, Iowa, and Washington. In 1997, the World Health Organization review of treatments for pediculosis noted the issue of lice resistance to almost all of the commercially available pesticide treatments including permethrin-based products. As recently as February 1999, the Journal of Parasitology reported lice resistance in England, following in the footsteps of journal reports from Israel, Czechoslovakia, France and the U.S. Resistance issues alone warrant that people be reminded in advance that products may not provide the positive outcome they seek. Repeated use of these products will not change product performance and may risk children’s health and contribute to more strains of resistant lice.
While absence from school or child care is a loss of educational opportunity and an encumbrance to working parents, readmitting an infested child is not the solution. A policy for head lice must consider not only the infested child, but also his or her peers who have already been successfully deloused or who have not yet been infested. All this considered, the No Nit Policy remains a sensible approach that sets the standard to serve and protect all the children in the group.
I. The Need for Education and Strategy:
II. A No Nit Policy is A Sound Policy:
III. Combing Technique Proves More Effective than Chemical Treatment:
IV. General Resistance:
V. Permethrin Resistance:
VI. Lindane Resistance:
VII. Malathion Resistance:
VIII. Carbaryl Resistance:
IX. Phenothrin Resistance:
X. Head Lice and Disease
