CUSD’s head lice policy is not supported by science

Editorial

Posted by on Sun, October 11, 2009

image
CDC
The nit is smaller than the statue of Lincoln inside the Lincoln Memorial on the back of the penny.

Recently, our family has had the opportunity to experience first-hand the Cabrillo Unified School District’s "no-nits" policy toward head lice.

The policy is broken.  Not only does it impose needless misery and expense on district families, it’s unsupported by scientific, medical or public health evidence.

Under the policy, no child will be admitted to school if there are nits (head lice eggs) present in the child’s hair. While no-nits policies are common among school districts, they are universally opposed by the very public health and medical organizations cited in the district’s policy: the Centers for Disease Control and Prevention, the California Department of Public Health, American Academy of Pediatrics, National Association of School Nurses, and California School Nurses Association.

The life cycle of a louse

The good news is that a couple of weekly treatments will kill any lice that hatch before they are mature enough (eight days old) to lay more eggs.

But there are no medications that can remove nits. Nor can hours of combing remove all the nits. Nits have evolved to stay cemented to a person’s hair. They can be tediously removed if they can be found, but only if you inspect every side of every single hair on the child’s head. There is a reason why nit-picking has become a metaphor for the futile pursuit of trivial outcomes.

That is why a no-lice policy is effective and a no-nits policy is no improvement.

The district’s cure is worse than the disease

The district’s no-nits policy causes unnecessarily lost school days. But most of the misery happens at home, away from the school.

The policy almost certainly results lost income and increased expenses for many Coastside families that work two jobs and cannot afford to pay for childcare.

Even more hidden is the unnecessary misery the district’s policy creates for parents and children.

I’ve seen parents discussing ineffective folk remedies, and futilely coming their childrens hair for hours in a vain attempt to remove nits. We have no idea how many have been driven out of desperation to overuse anti-lice medications.

Only the CUSD board can solve this problem

Because the no-nits policy was adopted by the district board last December, only the board can reverse the policy. I spoke to the board meeting Thursday night about why it must reverse the policy and I’m trying to get the board to put this on the agenda of its next meeting. 

Because the board only meets once a month, it’s critical for the board to strike down this prejudicial, punitive, and unscientific policy at its next meeting.

I know that the board is dealing with much weightier matters right now. But this is an opportunity for them to solve a serious district problem quickly and simply.

Follow the link for quotes from the CDC, California Department of Public Health, California School Nurses Association, and American Academy of Pediatrics saying why they oppose this policy.

 

Centers for Disease Control and Prevention

"No-nits" policies that require a child to be free of nits before they can return to school are not recommended. Children should be permitted to return to school or child care after appropriate treatment is started. Head lice can be a nuisance but they have not been shown to spread disease.

California Department of Public Health

There is no evidence that a no-nit policy prevents or shortens lengths of outbreaks (Pollack et al., 2000, Williams et al., 2001). The American Academy of Pediatrics, the National Association of School Nurses, and the Centers for Disease Control and Prevention are all opponents of classical no-nit policies (Frankowski and Weiner, 2002; Schoessler, 2004). In light of current research, CDPH now recommends a no-lice policy.

California School Nurses Association

Research and the literature do not support school exclusion for pediculosis. Because no disease process is associated with pediculosis, schools are advised to not exclude students when nits remain after appropriate lice treatment. However, further monitoring for signs of re-infestation is appropriate and recommended. Presence of nits does not indicate active infestation and there is no evidence that presence of nits correlates with any disease process. Other studies show that lice are not highly transferable in the school setting and no increase in outbreaks of lice resulted from allowing children with nits to remain in class. The California Department of Health Services does not support "No Nit" policies.

American Academy of Pediatrics

A child should be allowed to return to school after proper treatment. Some schools have had "no nit" policies under which a child was not allowed to return to school until all nits were removed. The American Academy of Pediatrics and the National Association of School Nurses (www.nasn.org/positions/nitfree.htm) discourage such policies.


>>Not only does it impose needless misery and expense

Reminds us of global warming hysteria… and that “science” ballyhoo.

Comment 2
Tue, October 13, 2009 8:20am
Barry Parr
All my comments

Kevin, I’m not sure what point you’re making.

My point is that scientific evidence, based on real-world data, is a better source of public policy that feelings.  That’s true in global warming and it’s true in public health.

This policy is based on nothing more than fear and irrational prejudice disguised as common sense.

Discussion of global warming is off-topic in this thread, but you’re welcome to post a letter on the topic if you really want to go there.

Comment 3
Tue, October 13, 2009 9:10am
Hal Bogner
All my comments

Barry - What a great article!

A minor, local version of the kinds of mistakes one reads about on larger scales, such as this:

Belatedly, Egypt Spots Flaws in Wiping Out Pigs
http://www.nytimes.com/2009/09/20/world/africa/20cairo.htm

A few brief excerpts:

“... But the crisis should not have come as a surprise.

When the government killed all the pigs in Egypt this spring — in what public health experts said was a misguided attempt to combat swine flu — it was warned the city would be overwhelmed with trash.”

Sadly, the policy could not be reversed, because it would be embarrassing to the president of the country to backtrack from decision, once the decision was announced:

“When the swine flu fear first emerged, long before even one case was reported in Egypt, President Hosni Mubarak ordered that all the pigs be killed in order to prevent the spread of the disease.

When health officials worldwide said that the virus was not being passed by pigs, the Egyptian government said that the cull was no longer about the flu, but was about….”

Perhaps the CUSD Superintendent could set aside the policy temporarily for good cause, and get his board to then address it quietly via the consent agenda, before this, too, gets covered by the NY Times and other major media.

Thanks for your really thorough and succinct coverage Barry.  I learned this stuff the hard way last year.  Since then I have been frustrated many times asking other parents to question the validity of the district’s “no-nit” protocol.  Besides the many disadvantages you mention here, this policy also tends to create a finger-pointing, witch-hunt mentality among desperate parents - another reason why the school board should do the right thing and take a leadership role on the issue.

Comment 5
Tue, October 13, 2009 4:26pm
jlundell
All my comments

I think Kevin’s point was clear enough, though granted a little skew of topic. CUSD simply reminds us all of climate-change deniers, in that they’re inclined to ignore science and its ‘ballyhoo’.

Of course, that might be unfair to CUSD; we’ll find out soon enough.

Barry,

I looked into your comments made at the Board meeting and in this forum on “climate change”?

Here is an excerpt from the actual policy:

“If a student is found with active, adult head lice, or untreated nits, he/she shall be excluded from attendance. The parent/guardian of an excluded student shall receive information about recommended treatment procedures and sources of further information. The student may be allowed to return to school the next day and may be checked by the nurse or designee before returning to class. Once he/she is determined to be free of lice, the student may be rechecked weekly for up to six weeks.”

This is consistent with the CSBA policies and incorporates the recommendations you referenced.

Upon examination, I would suggest this a pragmatic approach to provide a reasonable level of protection for our students. Please note the exclusion for “untreated” nits.

I hope this helps clear this up, and your kids are back in class.

Charlie

Comment 7
Wed, October 14, 2009 9:17am
Barry Parr
All my comments

Charlie, that’s not how the policy is being enforced.  Once a student is found to have head lice, they are kept out of school if any nits (treated or otherwise) are found in their hair. If that is not the board’s intention, it or the superintendent should issue a public clarification of the board’s policy.

You should also know there’s no such thing as “treated” nits. There are no effective treatments for nits—only for live head lice.

  http://www.cdc.gov/lice/head/treatment.html

You’re right that the California School Board Association does not support no-nits policies:

The American Academy of Pediatrics, the Centers for Disease Control and Prevention, the California Department of Health Services, and the California School Nurses Organization have updated their recommendations and issued position statements reflecting the management of head lice. Based on an analysis of scientific and medical evidence, it is the position of these groups that children with nits (not active, adult lice) are not contagious. Therefore, in order to minimize the disruption of the educational process, the groups now recommend that students with nits be allowed to remain in school and that students with active, adult lice be referred to their parents for treatment.

CSBA has revised its sample board policy BP 5141.33— Head Lice for consistency with these updated recommendations. Please see the Management Resources in BP 5141.33 for citations to the research.

Barry,

It’s a tough call. The site administration is directly responsible for the safety of all their students.

The policy (rightly or wrongly) calls for, “The student may be allowed to return to school the next day and may be checked by the nurse or designee before returning to class. Once he/she is determined to be free of lice,...”

I’ve been on your side of the issue. Ask the parents of a child without this how should it be determined that the child is free of lice?

Assuming you are correct that their is no such thing as “treated” nits, then by definition it would require exclusion. I think the safe policy is to insure the determination of “free of lice” is the standard, and consistent with the policy.
Wouldn’t you agree?

Comment 9
Wed, October 14, 2009 2:47pm
Barry Parr
All my comments

Charlie, I’m not sure I’m following you.

The board has a policy, which you tell me is a “no live lice” policy.

The schools are enforcing a “no nits” policy.

My questions:

1. What does the board believe its policy to be?

2. If the board believes it is a “no live lice” policy, are they allowing the principals to hold children to a stricter standard? if so, should I take this up with our principal?

3. If the board believes it has a “no nits” policy, please reread my story.

We can’t resolve this here, but I want to see the board address this issue at its next meeting.

Comment 10
Wed, October 14, 2009 4:31pm
Carl May
All my comments

Whether or not they are contagious, nits are a stage in the life cycle of lice and they are alive. So they could be considered “live lice.”

Seems to me the semantics need to be sorted out in the above messages. The whole nit thing has hints of the inappropriate “when does life begin” discussions one hears in the right to life debates.

Semantics, aside, the CDC refers to the two possible policies as “no live lice” and “no nits”.

Barry, you spent 18 paragraphs playing victim, but have you spelled out your proposed solution?  You want CUSD to “reverse the policy,” and the facts you state would seem to support a revision. But wouldn’t it be more constructive to specifically list here what your proposed new policy would be, and approach it that way, from the desired goal? Why not be proactive and use Coastsider.com to rally support for your specific policy recommendation?

I think you’d find the “CUSD should revise its policy to xxxx because 1-2-3” approach would have a greater chance of effecting change than “CUSD is wrong because 1-2-3.” And your readers would probably appreciate being able to debate actual policy options rather than hypotheticals.

Comment 13
Mon, October 19, 2009 12:13pm
Barry Parr
All my comments

Joel, I’m not playing victim. I disclosed up front that I have a personal interest (and experience) in this issue. It’s also time to remove the stigma associated with what is becoming a common childhood illness. I’m concerned about everyone who comes after us.

I’m not a public health expert, so I’ll defer to the CDC on this issue. The California School Board Association has already done the job of turning this into a policy recommendation, and have distributed a sample policy to their members:

“...that students with nits be allowed to remain in school and that students with active, adult lice be referred to their parents for treatment.”

That’s good enough for me.

I don’t understand your issue with my taking a negative stance to an existing policy that is so poorly researched and thought out. How badly researched? It contradicts the very references it cites! And it’s causing a lot of misery among district families.

The board policy ignores the expert recommendation of every scientific, medical, and public health body that has examined the research on this issue. 

What policy do you recommend, and why?

That’s what I’m asking you. That, and to be constructive, not destructive. If you want the policy be changed to “the child may return to school after the situation is treated” or whatever else it is that you want, start with that, then present your facts. Your headline could then read, “Change to CUSD lice policy could benefit students, family budgets.”

Comment 15
Mon, October 19, 2009 2:47pm
jlundell
All my comments

I understand Barry to be asking for the CSBA model policy, which sounds consistent with the original editorial.

No?

CUSD has so much to worry about as it is, perhaps head lice policies for the offended families should be treated as paramount, over budgets, test scores, truancy, agendas, talent pool, decaying infrastructure, day-to-day wherewithall, and that pesky morning drop off. However, me thinks had this been the OPs offspring rec’ving lice from an un-quarantined child (which by the way, many of us have seen occur from children being let back into the classroom too soon), the “reverse armchair quarterbacking on policy” would be threefold. Move along, nothing to see here folks.

Kevin: It wouldn’t take the board a lot of effort to adopt a policy recommended by the public health professionals. After all, they took time out of their busy schedules last year to adopt the current Medieval policy. Less time than it took them to recognize the 4H at their last meeting.

You were able to see the lice crawling from a particular child’s hair to that of another child? I’m startled at your visual acuity.

Sure, my particular situation led me to research the topic. I was startled by how out of step the district is with current public health policy. I’m not certain how that affects the validity of my argument from your perspective.

Do you disagree with the CDC, CDPH, APA, CSNA, and the CSBA?

The District has revised its interpretation of the policy, so that it is now a “no live lice”, rather than a “no nits” policy.

https://coastsider.com/index.php/site/news/district_revises_its_interpretation_of_head_lice_policy/