Part 9: The War On Lice
THIS MEANS WAR! ERADICATION OF THE BUGS.
As school nurses, we’re usually focused on a child with lice (but sometimes we are asked to do a head-check for a teacher). Often the child was itching their little head or a bug was actually seen crawling around on the child’s head by a teacher or even a student. When the child comes to my office, I maintain privacy and discretion. It’s embarrassing. Why is it embarrassing? After all, everyone is susceptible to getting lice. Everyone has discovered they had a booger in their nose after a conversation with another person. Everyone has had something stuck in their teeth, pimple on their nose, and experienced an accidental left-cheek-sneak, and yet we are all embarrassed when we individually experience any of these things. You get the point. No one wants to be or be the parent of “the kid with cooties.” It’s embarrassing. PS: Why didn’t they tell me I had a booger in my nose???
We may never know where the child caught head lice, but we now know the lice life-cycle. With that information, we can teach the parents to when perform the timely treatments to ensure that their child is free from lice and thereby reduced the incidences in your school. But, knowing when to treat is one thing. Knowing what to treat the child with...and the rest of the family with is another.
I don’t believe in the no-nit policy. Expended nits and even viable nits pose no threat TODAY for other children. What I do balk at are statements like this one from the NCBI:
“Although data on the prevalence of head lice in day care center attendees are not available, head lice exclusion policies are not warranted for schools or daycare centers because there is no sound medical justification.”
Technically, they are correct in saying, “...no sound medical justification.” But what about the financial justification? What about the social justification? What about the emotional justification? This article from parent.com may help us understand better: https://www.parent.com/the-5-stages-of-head-lice-from-denial-to-depression. There are dozens and dozens of articles out there that “justify” the reason children should go home from school if they have live and active lice.
“If you find live lice during the school day, it’s likely that child has had lice for weeks,” said Carolyn Duff, the president of the National Association of School Nurses and the nurse at an elementary school in Columbia, S.C. “Allowing that child to remain in the classroom for a few more hours is not putting children at risk.”
Ms. Duff is so right and yet so wrong. What if little Suzzie has been “lucky” for the “few weeks” that little Amber has unknowingly had lice. My thinking is this: Sometimes luck runs out. No, lice is not like the flu and I know that lice does not spread the flu or any other illness (save the emails). But we wouldn’t send the child back to class with flu-like symptoms. Why? Aside from the child feeling sick and not in an optimum state for learning, the child may pass the flu to someone else. But, consider this: They have had the virus all day and up to the time he or she was told to Go See The Nurse. And the other classmates are haven’t caught the flu yet, right? (I know the flu is more serious...the point is that the children have been exposed up to that point and by sending the child back to class knowingly exposes other children to the condition -- you get what I mean, right?)
Most of us school nurses want the lice out of the classroom upon discovery. Those that don’t...well...that’s okay too. However, let’s move from the debate to eradicate!
There are two methods to getting the job done. The one-two punch and the absolutely-sure-punch.
The one-two punch involves 2 steps. Step one is to use a pediculicide as soon as the lice are discovered and then follow up with step two about 8-10 days later when all the nymphs begin to emerge from the nits. In association with some of the other suggestions to follow, this is a simple-to-understand plan that many busy and/or complacent parents can follow. If we over-complicate it, many will not do it.
I am not a huge fan of this method though suggest it to parents that will not be able to follow the Nurse Kevin Lice Battle Plan which is a 5-6 treatment plan over 21 days.
If you have a parent that has a child with persistent head lice and they say they have tried “everything,” then go through the Nurse Kevin’s Lice Battle Plan with them. As you explain it to the exacerbated parent, they will find out quickly that they have indeed NOT tried everything.
Once a Week, Take a Peek - Nurse Kevin
I would suggest to parents that they take a close look through their child’s head each week to “catch” any signs of bugs. If a parent finds one big bug in the hair after having taken a thorough look just the week before, it’s likely that that big bug has just gotten there and they will not have to go through the whole, long, drawn-out process all over again.
CONSIDERATIONS WHEN TALKING TO PARENTS ABOUT HEAD LICE
Having head lice is an embarrassing ordeal. Often I will call a parent and initially feel embarrassment for them knowing the feeling they are about to get when I say, “Your child has head lice.” They will feel judged, dirty, overwhelmed and utterly embarrassed. There are a few tactics I use to ease these feelings and let them know that I am on their side.
If you find nits down the strands of hair, you know they have been dealing with this for a long, long time. They just do not know what to do. They may say they have tried everything but their child still gets lice. The desperation in their voices shows they have tried everything...but only the “everything” they are aware of. I have a Nix coupon on my desk right now that uses words like “Ultra,” “Elimination,” “Kill both Super Lice and regular lice, including eggs.” All of that tells you this stuff works great. But it doesn’t work 100% of the time. And, if one bug survives...guess where that parent is in a month’s time...yep, right back where they started.
You as the school nurse have the power to educate and even offer a home visit to show them what to do. Give them encouragement and lots of follow up calls. You can even bring the child into the health office and be the one to perform the: Once a Week; Take a Peek. If you know the parent is not looking, call the child down each Monday and take look through his or her hair. Do this on Mondays. If the child is going to stay with a relative or the other parent, it’s usually on the weekends.
You may hear, “I know! Every time she goes over to her dad’s house she catches lice from his kids.” This is a very manageable situation. Split families with scheduled visitation can be managed by an olive oil treatment after each visit. Let’s say the child goes to the other parent’s home every other week. When the child comes home, an olive oil treatment is done. We can educate the domicile parent about the life cycle of the louse. If a bug found its way into the child’s hair from daddy’s house on Sunday, October 1st, the mother can kill the louse with the olive oil on that same day that she returns to her home. If that louse laid 8 - 16 eggs over that weekend the child spent with the father, we have 2 weeks for the nits to gestate, hatch, and go through the 3 molting’s. That takes about 14 days. Coming home on October 14th after another weekend with daddy is another planned olive oil treatment. The nits that were laid two weeks ago are now dead and any new, piggybacking bugs end up going the way of the dodo.
There are those families who work so hard and still have so little. Olive oil, Nit Combs, and Pediculicides cost money. Ahhh, money is the least of it all. There’s no time! It’s up in the morning, work a 12-hour day (or more day) sometimes at two jobs and back home to get the four kids to bed. Consider the time involvement of the treatments and then multiply that x4 children (or more). Trust me, no matter what you do, that mountain cannot be climbed unless you show up. The truth of the matter is this: During the evenings, the children’s lice problem is mamma’s problem. But, during the day, the children’s lice problem is YOUR problem.
What I mean by “show up” is to offer the parents a home visit. I know, I know, they always say “no.” But, sometimes they say “yes.” When you offer a home visit, they picture strangers in their houses and may feel judged. The offer portrays a sense of urgency and action. If money is a problem, a real problem, talk to your principal and get some lice kits and olive oil...make this happen for the parents.
If the parents say, “Okay. Come to my house and help me.” Awesome, go over and get this done once and for all (but you better say on top of it by doing frequent head checks).
Occasionally you will get an obstinate parent who has no concern about the lice because “the lice don’t cause disease.” You will have to work with what you have where you are. Pure and simple. The truth be known, you are likely able to perform many “cares” for the child that any other parent may fuss over. I’ll explain with a story:
The children of the mother I mentioned at the beginning of this article was obstinate, overworked and over-broke. She had been fighting this for so long she’d given up. When her children started school that year, they were all short-haired...even the two younger girls. Very sad, right? At mid-year (and much hair growth), the only boy shows up with a fisted hand. He had no shame opening his hand in the nursing office and in front of the other children getting cares, “Found a bug Nurse Kevin! I found a bug!” In his hand was one great, big louse trying its dang-ness to crawl around on that boy’s extended hand...in MY direction. He had had lice for so long that he not only lost the “ick factor” but also had no fear of the social aspect of the risk of an elementary school children’s ridicule.
At that point I had decided to start combing the children’s hair each Monday. Given enough Monday, we would eradicate those bugs. Taking a chux pad (the incontinent pads for bed-bound patients), a spray bottle, a bit of either lavender oil or mint oil, and a nit comb, I put the children on my stool and dressed their shoulders with the absorbent pad upright on their shoulders. We’d secure the chux pad with a black paper clip and sprayed their heads with water. Using a wide-spaced comb to straighten their hair out, we’d end the spa-day with a good bit of nit-picking (now you know where that phrase came from). After our treatments (about 15-20 minutes tops), a few drops of essential oil was applied to my gloved hands and it was rubbed into their little heads. Yes, it was like a spa day for them; they actually loved it.
RID VS NIX
RID contains pyrethrum and NIX contains permethrin. But what does that mean? Is one better than the other at killing lice and what about all those eggs?
THE BATTLE PLAN
You’ve found lice on a head in your home. WHAT THE HECK!? Okay, don’t sweat. You’ve got this. Read this LICE BATTLE PLAN and get them bugs gone!!
ALL ABOUT LICE
Learn more about lice. You have an 2-3% chance of lice coming into your home this year. The more you know about these pests the better prepared you’ll be.