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AAP discusses head lice management

Frankowski B. Pediatrics. 2010; doi:10.1542/peds.2010-1308.

A revised clinical report issued today from the American Academy of Pediatrics clarifies and updates protocols for diagnosis and treatment and provides guidance for the management of head lice in the school setting.

AAP officials said in the report that no healthy child should be excluded from or miss school because of head lice, and “no-nit” policies for return to school should be abandoned.

Joseph A. Bocchini Jr., MD, a co-author of the report and an Infectious Diseases in Children Editorial Board member, said the AAP decided to issue the guidance because many school boards still have no-nit policies.

“We wanted to clarify that since nits do not transmit disease, it is inappropriate to keep children with them out of school,” Bocchini said.

The authors of the statement said there are some common sense approaches to reducing risk of transmission, starting first with selecting appropriate treatment.

In the statement, the researchers noted that 1% permethrin lotion is recommended as initial treatment for most head lice infestations, with a second application 1 week after the first.

Bocchini said parents and caregivers should make sure that any treatment chosen is safe; preferred treatments would be those that are easy to use, reasonably priced and proven to be nontoxic. He told parents to discuss the issue with their pediatrician, particularly in instances of treatment failure.

“Treatment failure is often related to a missed diagnosis or not following the manufacturer’s recommendation for treatment,” Bocchini said. “The first step is to make sure parents have a good diagnosis from someone who has some experience of what to look for, and then medication needs to be given appropriately, then the possibility of resistance needs to be considered.”

The statement also advises parents to carefully check a child’s head before and after attending a sleepover or camp where children share sleeping quarters, as head lice are spread through direct contact. The guidance also advises teaching children not to share personal items such as combs or hats. – by Colleen Zacharyczuk