Losing the Louse: How to Manage this Common Infestation in Children

Vicky R. Bowden, DNSc, RN


Pediatr Nurs. 2012;38(5):253-254. 

In This Article

Nursing Implications

Nurses play an important role in notifying parents about prevention, detection, and school/program treatment policies. The American Academy of Pediatrics (AAP) recommends that when a child in school is discovered to have lice, rather than being sent home, he or she should be discouraged from close direct head contact with others (Frankowski et al., 2002). Notification of the child's parents or guardian may occur by phone or written note sent home at the end of the school day. The importance of prompt treatment is emphasized as a means to treat the affected child and to protect others from infestation.

School and daycare facilities are encouraged to have nit policies in place that indicate when a child may return to school. The AAP and the National Association of School Nurses (2011) state that the child should be allowed to return to school after proper treatment (Frankowski et al., 2002). A treated child's hair should be examined on return to school for the presence of residual eggs, which could signal reinfestation or may indicate that treatment was not initiated. Screening for lice should be done so that confidentiality is maintained. Screening programs for lice should be instituted periodically, with parental notification given in advance. Screening is best completed by using disposable wooden screening sticks, which are used to separate hair strands and provide easy visibility, under good lighting, for the nurse to see the nits in the child's hair. New sticks are used for each child and provide a hygienic way for the nurse to evaluate the child's scalp without having the costly expenditure of using a clean set of disposable gloves to examine each child.

Lice infestations can be a source of embarrassment for the child and family members. Parents may feel upset and angry when they learn their child has acquired a lice infestation. It is important for the nurse to emphasize how easily lice are spread from one person to another, and how this condition does not reflect on an individual's personal hygiene habits. Nurses can provide home care instructions to prevent infestations and effectively manage spreading to other children and family members. Encourage parents to comb their child's hair each day and use this as an opportunity to assess the scalp for those pesky nits. If nits are discovered, they should be treated immediately, and others with whom the child may have close contact should be notified to assess for lice. Finally, children need not miss school or activities with friends because of lice.