Just Say No to Lice, but not to Nits

Just Say No to Lice, but not to Nits

Lice, Nits, and School Policy
L. Keoki Williams, M.D., Amanda Reichert, M.A. William R. MacKenzie, M.D and colleagues
Pediatrics, Vol 107, No 5 May 2001

Lice inspections have become a fact of life in schools and children’s programs across the country, with children required to leave school and other programs if they have any signs of lice or nits (egg casings). But nits can contain a developing head louse, which is contagious, or can be an empty shell, which would not be contagious. With an estimated 6 to 12 million lice cases in the U.S. every year, lice policies affect millions of families and thousands of schools and programs every year.

In this study of 1729 children enrolled in two elementary schools, 5% had head lice. The study focused, however, on the children who had nits, but no lice.

According to school policy, all children found to have lice had to be picked up from school by their parents and could not return to school without proof of treatment. However, of 50 children with nits but no lice, only nine (18 percent) became infected with lice during the following two weeks. The total number of nits that a child had in his or her hair did not predict whether a child would become infected. Even more surprising, whether or not the children received treatment for lice did not affect whether or not the children with nits ended up with lice.

The authors conclude that many children who are not infectious and will not themselves get lice are being removed from schools that have a "no nits" policy. In addition, requiring treatment for nits may be inappropriate, since there was no evidence that it decreased the likelihood of subsequent infestation. (Although not mentioned in this article, lice treatment is a highly toxic chemical which is unpleasant to use and presents some risks to children’s health). These study results have clear implications for schools and for other programs for children and youth: there is no need to exclude (and stigmatize) children who have nits if they don’t have lice.