Any evidence of lice was once reason for immediate dismissal from school, with no return until the student's head was lice free. But "no-nit" policies have been dropped in favor of "nonexclusion" rules, prioritizing class time over any nuisance caused by the sesame seed-sized parasites.
That leniency, of late, is coming back to bite some schools.
Parents in Massachusetts, Texas, Ohio and Georgia are petitioning for their districts to go back to strict rules on nits and live lice. They blame recent outbreaks on the inclusive recommendations from the Centers for Disease Control and Prevention that allow students with live lice to remain in class. Before the start of this school year, the Hernando School District north of Tampa, Fla., acted to reinstate a policy that was abandoned in 2022.
"It's a reinfestation, over and over and over," says Shannon Rodriguez, who chairs the Hernando County School Board. In July, she told fellow board members that she has seen the vicious cycle among families. "What do you do as a parent? Put them back in school with the same kid or kids that are in the classroom who have [lice]? It's just a never-ending battle."
It's hard to know whether more inclusive policies have anything to do with isolated outbreaks because there's very little data on infestations. Public health officials see lice as a nuisance, not a health threat. Outside of small studies, data collection is scarce.
The latest estimates for annual infestations in the U.S. are broad and unreliable since so many cases go unreported. The CDC puts the number between 6 million and 12 million, mostly in preschoolers and elementary school-age children.
"It really is about education because there are so many myths and so many misunderstandings about lice out there," says Cathryn Smith of the National Association of School Nurses chapter in Tennessee. "This isn't a topic that most people talk about."
The National Association of School Nurses and the American Academy of Pediatrics have supported nonexclusionary head lice management for years, dating back to at least 2002. But the recommendations were taken more seriously after the COVID-19 pandemic affirmed the importance of face-to-face schooling.
"I think that people are starting to realize the value of in-person school and that really anything that takes them out of that should be scrutinized," Dr. Dawn Nolt of Oregon Health & Science University told NPR. "Head lice is not a valid reason to keep a kid out of school or be dismissed from school."
Nolt authored the latest guidance issued by the American Academy of Pediatrics, in 2022, which incorporated new research but largely echoed prior versions. It discourages widespread lice checks in schools since a small study found that more often than not, lice are misidentified, which leads to unnecessary treatment.
The life cycle of lice also takes four to six weeks to become a full-blown infestation. Only then would a child be seen scratching their head uncontrollably, something caused by an allergic reaction to the lice saliva.
"Kicking them out on a Wednesday when they've been having it for the past four to six weeks is not going to do anything. But it's going to take that kid out of school and shame that kid and shame that family," Nolt says. "I just think that's not acceptable."
Inclusion is the priority, even if it may cause an inconvenience or financial cost for others. Over-the-counter remedies like creams, gels or shampoos add up. Professional treatment, which often involves manually picking out lice and nits, can run into the hundreds of dollars per person. And sometimes lice hit an entire household.
This summer, a preschool outside Nashville, Tenn., was hit with an outbreak like never before. Roughly a third of the kids at Creative Youth Enrichment Center ended up with lice.
Owner Tonya Bryson knew the latest recommendations are to play it cool. So she kept everyone in school, and they faced the dreaded four-letter word together. And then she talked about the experience openly.
"It's not as bad as you think it is," Bryson says. "I mean, yes, we had quite a few kids with it, and then it went to parents and siblings. But it's manageable."
Among the affected families was Stephanie Buck, who also teaches at the day care. Lice ran through her household, requiring pricey treatment to rid them all.
She's torn about the best approach, balancing the shame and stigma with the practical matter of containing an outbreak.
"Because my daughter was really embarrassed when she found out that she was the first one who got checked and she had it," Buck says. "It's hard. You want to protect your babies' hearts, but you also want to keep them from getting lice."
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