This briefing offers information and advice from the National Union of Teachers (NUT) on how to tackle the problem of head lice in schools, including facts about head lice and treating the problem and sources of further advice and assistance for teachers and parents.
What are head lice?
Head lice are tiny insects which live in the hair and feed by biting the scalp and sucking blood. The female head louse lays her eggs close to the scalp where it is warm enough to incubate them. The eggs, or nits, hatch out, start feeding and soon begin to lay more eggs. Empty egg shells are left attached to the hair when the louse hatches.
How are they transmitted?
Head lice are caught by head to head contact with someone who already has them. Although anyone can catch them, they prefer the heads of 4-11 year olds. Clean hair is no protection against them. When heads touch, the lice simply walk from one head to another. Adult lice take every opportunity to exchange hosts to avoid extinction through in-breeding.
Shared brushes and combs can also transmit lice so schools should discourage children from sharing combs and brushes. It is also sensible for schools to stipulate that the school photographer should not use the same comb to tidy every child’s hair.
Shared hats, headphones and jackets hung close together do not, however, present a risk. This is because head lice that involuntarily fall off the head or clamber on to clothes or other articles, such as pillows or cuddly toys, are dying and harmless.
What are the signs of head lice infestation?
The way head lice feed causes itching, so scratching the scalp is usually the first sign that a child has head lice. It should, however, be pointed out that the onset of itching may be delayed by weeks, or even months, when someone first catches lice. Another sign of head lice may be a rash on the base of the neck caused by lice droppings. Anyone who has had head lice for a while may begin to feel generally unwell or ‘lousy’.
How are head lice detected?
Lice are most easily detected by combing really well conditioned soaking wet hair with a fine-tooth comb. Really wet lice stay still and cannot escape. Combing dry or damp hair with a fine-tooth comb is not a reliable way to detect lice. In dry or damp hair, lice move quickly away from the disturbance caused by a comb. Regular head inspections in school, therefore, are of dubious value because only the most severe cases are likely to be detected. Many milder cases will be overlooked, thus lulling parents and schools into a false sense of security.
What is the treatment?
There are two main methods of dealing with head lice infestation: wet combing and use of insecticidal lotions.
> Use of Insecticidal Lotions
Various lotions are available to treat head lice. They should only be used when live lice have been detected. There are three main groups of chemicals: pyrethoids, malathion and carbaryl. Carbaryl is only available on prescription. Apart from being expensive, there are concerns that head lice are becoming resistant to these treatments and that they may be unsafe when used repeatedly. They should be used with caution by infants, pregnant women, breastfeeding mothers and anyone with asthma, eczema or other allergies. Even if treatment is successful, the child may catch lice again shortly afterwards. In the instructions for use, malathion, carbaryl and pyrethroid products (lotions and mousse) advise against treating hair more than three times successively at weekly intervals. Community Hygiene Concern suggests that this instruction should apply to any combination of insecticides.
> Wet Combing or ‘Bug Busting’ Method
The ‘bug busting’ method is an alternative method, devised by the charity ‘Community Hygiene Concern’, which avoids the use of insecticides. After washing the hair, copious amounts of conditioner should be applied and, after detangling with an ordinary wide-toothed comb, the hair should be combed, sitting upright or leaning over the bath, from the roots with a special ‘bug buster’ fine tooth comb, with the teeth of the comb slotting into the hair at the roots with every stroke. After each stroke, the lice should be cleared from the comb.
Wet lice find it difficult to escape from this combing. Hair which is slippery from conditioner makes it hard for them to keep a grip and so removal with the comb is easier. The lice should then be wiped onto kitchen paper and disposed of, or simply rinsed away. This routine should be repeated every 3-4 days for two weeks so that any lice emerging from the eggs are removed before they can spread. Given that head lice do not lay eggs until about a week after they have hatched, it follows that removing the live lice regularly will result in lice-free children in a fortnight. Re-infection can, of course, occur if head to head contact is subsequently made with someone with head lice. ‘Bug buster’ kits, containing instruction leaflets, five combs (a de-tangler comb and combs for removing baby and adult live and empty shells) and a plastic cape, are re-usable, and are available from some local chemists or from Community Hygiene Concern (see below for address).
What can schools do to prevent head lice spreading?
Head lice infestation, particularly when repeated, can cause great distress. Generally speaking, teachers and parents who become infested are likely to feel more squeamish than children, who often have a more matter-of-fact approach.
Schools may wish to consider the following approach to head lice prevention, which involves obtaining the co-operation of parents.
- Parents should be provided with information on ‘bug busting’.
- Schools may wish to supply parents with ‘bug buster’ combs. Bulk buying can reduce the cost.
- Parents should be requested to check their child’s hair regularly, using the ‘bug busting’ wet combing method described above, and inform the school as soon as they discover any head lice.
- If an outbreak occurs, all parents should be sent a standard letter, alerting them to the outbreak and asking them to take part in a ‘bug busting’ campaign, involving careful combing of the whole family’s conditioned hair with a ‘bug buster’ comb every three days over a two week period. All parents should be asked to take part, regardless of whether they think their child has lice, since without rigorous checking the lice are easy to miss. Teachers and their families should also participate in the campaign.
- Parents who choose to use an insecticidal product should also be advised to ‘bug bust’ 3-5 days after application, to check that no lice remain after the treatment and to clear any new lice which may be caught, before they multiply.
What can Teachers do to Prevent their own Hair becoming Infested?
The only sure way is to avoid head-to-head contact with infested children.
Dealing with cases of repeated infestation
The NUT sometimes receives enquiries about cases where particular children are known to be the source of regular re-infestation of other pupils, sometimes due to parental negligence or refusal to take the above steps to deal with their children’s own infestation. If, in such circumstances, NUT members feel that neither their school, nor their health authority, is taking the problem seriously, the NUT will offer advice and assistance. Health authorities can help by providing schools with standard letters to send to all parents when an outbreak of head lice occurs.
As a general rule, the NUT does not favour excluding children with head lice from school in such circumstances. Excluding the child is unlikely to solve the problem and the child would suffer the stigma of exclusion for a reason beyond his or her control. Other contagious, but less noticeable, cases will probably remain. Exclusion is not used for other conditions with low transmissibility, such as verrucas and herpes simplex and, although unpleasant, head lice do not constitute a threat to public health.
Families with recurring or continuing infection need to be supported by health professionals, particularly school nurses. They should be prepared to make a professional assessment of reported cases, provide appropriate information, support and advice to teachers and parents and undertake home visits if that is deemed to be the most tactful and effective method of dealing with the problems of a particular family.
Further Advice and Help
Further information and materials such as leaflets, stickers and videos for use in schools can be obtained from:
Community Hygiene Concern
22 Darin Court
Milton Keynes, MK8 0AD
Advice Helpline 01908 561928
‘The Prevention and Treatment of Head Lice’, published by the Department of Health in February 2000, is available from Department of Health, PO Box 777, London, SE1 6XH.