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Tuesday, July 27, 2010

Got Lice? The AAP says, "Don't worry your pretty little head one bit!"

Perhaps you've heard of the American Association of Pediatrics guidelines for dealing with head lice? Their primary recommendation is that children with head lice should not be kept home from school.

Yes, you read that correctly. NOT. be. kept. home. Their logic is as follows:

1. Education is too important. Children with a problem that does not cause a disease should not be missing valuable schooling.

2. Head lice do not jump or fly and hence can only be spread by head to head contact. Children in elementary schools, unlike preschoolers, do not tend to roll around on the floor or touch heads. And simply sitting next to a kid who has head lice won't give you head lice.

3. While admittedly an annoyance, head lice are not an illness. They should not be treated as a disease.

If you want to see more about their position, you can watch a segment from this morning's TODAY show and read the accompanying short article.  Or go read the full AAP report (initially released in 2002 and reaffirmed in 2009.)

It is, in short, pretty horrifying how cavalier the medical experts are about this problem, treating it simply as a medical issue and arguing that "no nit" policies that are in place in schools are doing a disservice to children who miss valuable days of education while they are trying to get rid of head lice.

The full report is more nuanced, of course, but the TODAY show segment is reductive and misleading about how difficult it is to get rid of this problem, and is almost willfully negligent in not considering how lice may be spread or the disruption lice can cause both in classrooms and at home.

While technically, of course, the doctors are right that only direct contact with lice can spread lice, it is as if this recommendation was written by a group of doctors who have never actually seen an elementary school child (despite being pediatricians). In many elementary school classrooms, the children:

*  share cubbies, which means their coats and hats are touching, so one kid's lice can spread to another's hat.
*  have circle time rugs in lower grades, and reading corners filled with pillows in many classrooms.  All it takes is one kid with lice lying down in such a place for the next kid to pick up a louse or two.
*  have community property like art smocks (pulled on over the head), computer headphones, or the Birthday Kid Crown, that get passed from one kid to the next.
*  put their heads together to whisper secrets during lunch.
*  lean over each other's desks while working on group projects.
In short, elementary school and middle school children are kids, and they are friends, and they are in close contact eight hours a day. If one kid in the classroom has lice, and it is left untreated, there is nothing but certainty that other children in the classroom will get lice--even though they are no longer in preschool and "rolling around on the floor" as the doctor quoted on the TODAY show indicated.

To be fair, the AAP is not recommending that head lice not be treated. However, their sense of what it takes to get rid of lice seems woefully underestimated (one treatment of shampoo + a combing, then a follow-up combing in nine days).

They mention nothing of what I've seen in friend who have had to get rid of the problem: delousing shampoo and daily comb outs of the hair, HOT water washes and HIGH cycle drying of every piece of bedding, clothing, etc. with which the child has come in contact, daily vacuuming of the house, bagging up or any toys/items that cannot be washed. In short, about two full days of cleaning, plus daily maintenance for two weeks is neceessary to get rid of lice. It is tremendous trouble and expense.

What if you go through that as a conscientious parent, and then some other parents see these guidelines that say it's okay to send your kids to school with lice, and they do nothing? And then your kid gets lice again. And again. And again.

Because that's what will happen. Constant reinfestation.

The coverage on the TODAY show is shameful for not including any educators in their discussion to get another perspective on the issue.

What about the fact that a prolonged lice infestation causes tremendous itching, which is hugely distracting to a child trying to learn? What about the intense quantities of cleaning that a teacher will have to do in her classroom to try to ensure that a child with lice doesn't spread it to other children?

Surely no one thinks that children will learn better in an environment in which half the kids are driven crazy by itching, and the teacher--who already has enough on his plate--now has to do louse damage control too?

Surely, the prevention of spreading is far preferable to epidemic conditions? Surely no one thinks that lice are simply benign creatures with whom we should agree to coexist happily?

I can't believe the short-sightedness of this guideline, which could influence legislation or school policies.  Though I don't imagine many schools jumping to encourage lice in their schools, I can imagine the parents of students who are forced to go home due to lice contesting such policies.

At what point does common sense dictate that the standard for whether children should be in school is not simply "are they ill and contagious?" Because I, for one, will not be delighted if my kids' school changes its policy and says it's just fine for kids with head lice to keep right on coming to school every day before the problem is under control.


Anonymous said...

My kid's school changed the policy last year and it didn't seem to change the state of affairs one way or another. I personally think the combing -- carefully, frequently -- is the most important and the thing people stint on because it is time consuming, a PITA, and makes the kid complain.

Mrs F with 4 said...

Golly, I would so NOT be impressed. I'm totally happy that any of my children are instantly removed from the classroom, collected and brought home to be treated. Enjoyable? No. A PITA? Absolutely. Necessary? Oh, I think so.

We also have the Nit Patrol, a battalion of volunteer mothers that instantly forms up and marches into the affected classroom to inspect all the other children. Um, I'm not actually one of them... my specialist volunteering skills are deployed elsewhere in the school.

Molly said...

My mom had a child pull a lice bug out of her head in class. It was pretty narsty.

I NEVER got lice until my junior year of college. I think I got it from my little sister, who got it from.. well, I have no idea. But let me tell you. IT SUCKED! Apparently there are professional lice ladies who come and treat your head. I contemplated shaving mine. Trying to deal with lice in a college dorm is the WORST. Kids should be KEPT HOME! Lice is such a PITA!

My head is itchy just thinking about this.

Ann Imig said...

This is ONE parenting HELL I have yet to encounter.

please no..please??

Singing Wendy said...

And as a teacher, let me tell you that once it settles into a classroom, it can be darn hard to get rid of. I know one classroom that had such constant outbreaks that the children were all required to put their coats, back packs, and basically anything else they brought from home into garbage bags everyday before putting it into the coat area.

I can honestly see reducing the amount of time a child is out of school after treatment....because I think in our district is was something like 3 days, which is unnecessary if you've done all the hair, clothing and bedding washing....but to say they can stay in school is kind of crazy!

Nanny Goats In Panties said...

WTF? Of COURSE there will be kids whose parent do not treat the lice as well as others, so OF COURSE kids should be sent home. And can't the kids be sent materials with to learn while at home?

BusyDad said...

I shaved Fury's head when there was a scare at his preschool. But really, I just wanted an excuse to make him look like mini-me :)

Anonymous said...

New lice preventive shampoo available at Wal mart-I am sure other places too-with Rosemary oil, and other essential oils-it makes you smell like you have been to the vet-but after all this nitpicking-we will use this for a while with the "girl who shall not be named" still attends my daughter's classroom. It is called lice shield-but other tea tree shampoos work as well. Prevention is the bomb!


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