Kids With Head Lice Don't Need To Miss School, AAP Stresses In Updated Guidelines

Now that kids are back in the classroom, the American Academy of Pediatrics (AAP) has issued new guidelines just in time for lice outbreaks in school. The new report dispelled some myths about transmission and clarified the ways that lice actually spreads from head to head. It discussed treatments, but also focused on the psychological stresses that can affect kids who are quarantined. According to the experts, forcing students with head lice to stay home may actually be worse for them.

As soon as a case of lice is discovered, it seems like everyone is itching their heads and a panic can spread around kids and parents quicker than the latest school gossip. There are also a lot of misconceptions and anxieties surrounding head lice, and how contagious they really are. “In most cases, transmission occurs by direct contact with the hair of an infested individual, the most common situation being head-to-head contact,” the AAP explained in the new report called “Head Lice,” published in October 2022. “Indirect spread through contact with personal belongings of an infested individual (combs, brushes, hats, sport helmets) is much less likely to occur."

In a recent Instagram post, the AAP shared a link to their findings and recommendations. “Lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. This revised clinical report clarifies current diagnosis and treatment protocols,” the peer-reviewed journal captioned the post.

One of the most important guidelines to come from the full clinical report is that kids who have lice should not have to miss important class time too. “Head lice are an unpleasant part of the human experience, but they can be successfully managed and are no reason for a child to miss school,” said Dawn Nolt, MD, MPH, FAAP, lead author of the report. “The AAP encourages pediatricians to serve as an educational resource for families, school districts and communities so that head lice may be treated and managed without stigma.”

The last time the AAP released a full clinical report on lice was in 2015. This revised report is much more focused on the psychological stress lice can cause both parents and kids. “It is important for medical providers to educate and reassure affected individuals and caregivers that head lice are neither a health hazard nor a sign of poor hygiene and are not responsible for the spread of any disease,” the updated guidelines explain. “Despite this knowledge, there is significant stigma resulting from head lice infestations in high-income countries, resulting in children and adolescents being ostracized from their schools, friends, and other social events.”

In addition to the anxiety that comes from isolating a student, forcing a child to say home might actually be a legal issue, the AAP says: “A child or adolescent should not be restricted from school attendance because of head lice, given the low contagion within classrooms. 'No-nit' policies that exclude children or adolescents until all nits are removed may violate a child’s or adolescent’s civil liberties and are best addressed with legal counsel for schools.”

In terms of treatment, the AAP recommends topical agents approved by the Food and Drug administration that contain pyrethroids. And if you’re looking to pick out those tiny eggs by hand, a fine-tooth comb is the way to go. The report also noted that in-school lice screening programs have been largely unsuccessful. So always best to check in with your pediatrician for the proper diagnosis and treatment plan.