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September 27, 2022

Children with head lice can remain in school, new AAP guidelines say

An infestation does not indicate that a child has poor hygiene or an unclean living environment, pediatricians stressed. They can be successfully managed without children needing to miss class

Children's Health Lice
Head lice school Sharon Gekoski-Kimmel/Philadelphia Inquirer/MCT/Sipa USA

Most cases are easy to treat, but there is a lot of stigma attached to having head lice. People mistakenly assume that head lice are a sign of poor personal hygiene or an unclean living environment, or that head lice carry disease.

Head lice infestations are a common part of childhood, but parents still dread getting a letter from their children's schools saying they need to check their kids for the little insects. 

Head lice are very small insects that feed on blood from the human scalp. They usually spread from the hair of one person to the hair of another through direct head to head contact, according to the Mayo Clinic. They more commonly affect children than adults.

About 1.6% of U.S. children will get head lice and 3.6% will have eggs, known as nits. Studies have shown that head lice do not appear to be influenced by hair type, length or frequency of brushing or shampooing. They also spread commonly among people of all socioeconomic backgrounds. 

Most cases are easy to treat, but there is a lot of stigma attached to having head lice. People mistakenly assume that head lice are a sign of poor personal hygiene or an unclean living environment, or that head lice carry disease.

To reduce this stigma, The American Academy of Pediatric's new guidelines on diagnosing and treating head lice – the first since 2015 – emphasize that better education can help parents and schools more effectively deal with infestations. They also state that children with head lice should be permitted to remain in school. 

"Head lice are an unpleasant part of the human experience, but they can be successfully managed and are no reason for a child to miss school," said Dr. Dawn Nolt, lead author of the report.

Diagnosing Head Lice

Head lice are visible with the naked eye, but they sometimes are hard to spot because they avoid light and can crawl quickly, the AAP says. Studies have shown that a louse comb with finer teeth is a quicker and more efficient way to diagnosis head lice than using a standard comb. Some experts also suggest using a lubricant such as water, oil or a conditioner to slow the movement of the lice. Handheld magnification also can help.

It is important to not confuse nits or lice eggs with hair debris such as dandruff, dirt, hair casts or piedra, a fungal infection of the hair shaft.

"Many presumed lice and nits submitted by physicians, nurses, teachers and caregivers to a laboratory for identification were found to be artifacts such as dandruff, hairspray droplets, scabs, dirt or other insects (eg, aphids blown by the wind and caught in the hair)," the updated guidelines say.

Safe, age-appropriate treatment

Topical agents, such as shampoos, lotions and other Food and Drug Administration-approved products containing pyrethroids are typically the first-line treatment for head lice. The AAP recommends using affordable treatments that quickly eliminate all live lice and nits.

If a child develops a resistance to these products, there are alternative treatment options available as well, including essential oils and other home remedies.

Parents are encouraged to talk to a pediatrician to ensure the proper diagnosis and discuss the safest and most age-appropriate treatments.

The AAP also says head lice screening programs in schools have not been proven to significantly reduce the incidence of head lice in school settings, nor are they cost-effective. These programs often stigmatize children who are suspected of having head lice. Instead, educational programs that help families better understand how to manage head lice would be more effective, the AAP says. 

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