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Bugs and Gaps- what’s the connection?


eva_general[2]Achievement gaps.  Those reports, the watch lists, and strategies to help ensure all students are successful.  I wish that we could add “attendance gap” to the list but that’s a topic for another day…

So what do bugs have to do with gaps?  Maybe quite a bit.  When I started in school nursing, I came across lists that a savvy former nurse had kept regarding follow up for students diagnosed with “live lice”.  Her record-keeping was quite telling.  Children were being excluded from school for weeks at a time, the school bus would refuse to pick them up, and there weren’t enough nurses to do all the checks so there were really no guidelines as to who was diagnosing the children. I imagined her frustration as she had to deal with the issue day in and day out.  Why were these practices so telling? At the time, the district had one of the highest dropout rates in the state.  I couldn’t help but believe that had a lot to do with the way kids were made to feel about school early on.

Anyone who has been subjected to standing in a room full of kids having their heads checked, and then later asked to go home from school can understand the dread associated with these practices.

Does it happen this day and age? Absolutely.  Scan the internet for policies related to head lice in school districts and see what practices exist.  The Centers for Disease Control and Prevention, American Academy of Pediatrics and Harvard School of Public Health have been quite clear regarding the harm of no-nit policies and school exclusion for head lice, yet districts continue to send children home.

If you look at the children in your classroom or school struggling academically, often they are the ones with the most obstacles to overcome.  That’s why the identification of “gaps” even exists.  Those families living in poverty often end up living in close quarters with other extended family, sharing rooms and beds and have circumstances where lice is easily transmitted from one child to the next. Sometimes getting treatment is difficult, and since lice are often resistant to the products Medicaid and CHIP insurances are most willing to  cover, the problem is not easily corrected.  Parents are then often accused of neglecting to care for their children.

I had a parent (a local minister) call  one time wanting to know what I was going to do to take care of the “lice problem” at his daughter’s school.  In conversation I found  the “problem” was that his 6 year old daughter was telling him  a girl in the class had head lice and she wasn’t being treated.  His complaint was that the district did not have a “no nit” policy to make sure his child wasn’t exposed.  I explained to him that the school nurse would do follow up with children who have lice and his daughter would not know that he/she had been checked.  I also explained that nits cannot be passed from one person to the next.  His response?  “I don’t want my daughter around THOSE children!” (Also bear in mind he was getting his information on what was and wasn’t being done from the perspective of a 6 year old!!)

In our jobs there are just “children”.  Children who all deserve a chance.  When we set them up to miss school repeatedly, we set them up for failure.  When they fail, they become a burden to local resources in our communities and the cycle is perpetuated.

There is a way to deal with head lice, using national guidelines and science.  It doesn’t mean ignoring the issue altogether- it means following up in a way that helps resolve the problem.  It means taking a look at other practices that might be impacting the gaps in our schools and finding new approaches to intervene. The most basic of which is not looking for ways to keep them out of the classroom.

I find it helpful to use a flow chart to help keep on track with students that have ongoing issues with lice.  The flow chart allows a nurse to document what treatments have been utilized, along with what teaching has occurred for parents.  It won’t cure the issue- anytime children are together in one place (and can put their heads together) we will have head lice.  But it can help ensure proper treatment and support for children to be where they learn best, in school!

A copy of the flow chart mentioned above can be found at:

Lice is often to blame for high emotion and distress.  Hold firm to your mission of advocating and supporting all children. Follow the guidelines and  remove barriers which can help in your work to reduce gaps in the children you serve.



Those Pesky Critters……….



School is  back in session.  The children gather and lots of little heads are  in one place. With that comes all they bring with them.  Time for reading , writing and head lice.  Yes, lice.  They are in your school, and in your classrooms. You can use this PowerPoint for yourself or to teach others the basics.

When my youngest was in kindergarten, she had blonde hair down to her backside. And imagine my surprise when I found a headful of those lovely creatures one afternoon. It was a good lesson for me in empathy for  families.  It took us quite some time (and a haircut) to be rid of them, despite hours of nit picking, hair combing, an electric lice shocking device, olive oil, and over the counter products. I even had a microscope at home to try to figure it all out.  When I saw her with her baby doll between her knees one day, pretending to pick nits- I knew my approach needed to change.  Many weeks had passed… it was time. One treatment with a prescription product and we were done!  (There are lice that are resistant to some of the over-the-counter products and that’s what we had)!

You discover one or more children in your school or room with head lice.  What are you to do?  The first thing is to keep calm! Lice are a nuisance and a pain but are NOT a health risk. They are not known to carry disease in the United States.   Secondly, if you haven’t already- you should educate yourself on how they are passed from one person to the next.  Despite what you may have been told- they do NOT jump or fly.  Head lice are passed by direct head to head transmission. Meaning, one head needs to touch another.  There are theories that they can live in carpets and various inanimate objects but the evidence says this is just a theory.  And the lice in your school aren’t setting out to look for other places to live. They are perfectly content where they are as long as a human head is involved.  If they get passed along, it’s due to happenstance- they aren’t mounting expeditions looking for a new home!!

When kids get head lice there is a course of action that should be taken, and the ultimate fix often isn’t with just one treatment.  Children should only be treated when live lice are present, nits do not confirm an active  case.  When a child is diagnosed with head lice a pediculicide (medicine which kills lice) should be used. The American Academy of Pediatrics recommends starting with 1% permethrin lotion (Nix) initially.  This product is not 100% ovicidal (meaning it doesn’t kill all the eggs) so a second treatment is needed in 7 to 10 days. What does this mean for folks in school?  That it’s normal to see live lice again after treatment in about a week and not that kids have gotten them again.  There are lots of “natural” products available but medical studies have not supported their effectiveness.  There are several websites supporting things like “no- nit” policies and exclusion of children from school.  Organizations such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics say these policies are counter productive and should not be adopted.  For more information on head lice treatment go to:

Often I see the same children repeatedly dealing with head lice.  This becomes frustrating for schools.  In these situations families need additional support. Hopefully you have a school nurse who can be involved (if you don’t- your school needs one!)  As mentioned earlier, lice can be resistant to over the counter treatment so a health care provider may need to be involved.  In my own situation I know I was doing the “right” things yet it was still difficult to get rid of.  The prescription medicine made the difference.  Sometimes we have to help families understand or get additional help.

You may be thinking that we need to just go straight to prescription medication.  That is not recommended because lice will soon become resistant to those treatments if over used.

In my years of school nursing, head lice has been what has gotten me yelled at the most, by parents and by school staff, and any of you who work in schools can likely say the same. It’s a very emotional issue, and no one wants to have head lice.  The more you educate yourself the better.  Not only to help decrease the spread in your school and classroom, but also when it comes to knowing what to do to help.  When you discover lice in a student, I recommend the following:

1.  Make sure it’s really lice.  That sounds crazy but there have been studies showing that many times kids are diagnosed with “lice” in school when they don’t really have it.

2. Check your school/district policies.  Most kids have had lice for a month or more before it’s discovered. The American Academy of Pediatrics and the Centers for Disease Control and Prevention do not recommend they be sent home that day.  You need to know what your policy says but know that it hurts them academically when they are excluded.

3. Make sure the school nurse is involved (I do so hope you have one). She/he is a great support and help for you and families.

4. Let the parent/guardian know.  Hopefully you have a nurse or resource who can help guide them through the best options for treatment.

5.  Know that its normal to see live lice  in 7 to 10 days.  This doesn’t mean they got it “again”.

6.Check your practices or (if you aren’t a teacher) the classroom where the student(s) are- do the kids lay in a spot (such as a special reading place) with their heads all together?  Are their coats/jackets all piled up in one place?  These could be ways to transmit at school!

7.  Know some good referral sources (this is for school nurses as well!)  I teach parents that they should do an over the counter permethrin or pyrethrin (if no allergies), and then to repeat in 7 to 10 days.  If they see live lice in their child’s hair  7 to 10 days after that second treatment I usually refer to their health care provider, or assist the families in getting a prescription medication.

The problem can be a challenge but we are smarter than the critters! Don’t let it be a barrier to your success in school!