This article is from a partnership with WPLN, NPR, and KFF Health News. It can be republished for free.
Any evidence of lice was once a reason for immediate dismissal from school, not to return until the student’s head was lice-free. But what are known as “no-nit” policies have been dropped in favor of “nonexclusion” rules, prioritizing class time over any nuisance caused by parasites the size of sesame seeds. That leniency, of late, is coming back to bite some schools.
Parents in Massachusetts, Texas, Ohio, and Georgia are petitioning for their districts to revive strict rules on nits and live lice. They blame recent outbreaks on the inclusive recommendations from the Centers for Disease Control and Prevention that allow students with live lice to remain in class. Before the start of this school year, the Hernando County School District, north of Tampa, Florida, acted to reinstate a policy abandoned in 2022.
“It’s a reinfestation, over and over and over,” said Shannon Rodriguez, who chairs the Hernando school board. In July, she told fellow board members that she’s seen the vicious cycle among families. “What do you do as a parent? Put them back in school with the same kid or kids that are in the classroom who have it? It’s just a never-ending battle.”
Public health officials consider lice a nuisance, not a health threat. Outside of small studies, data collection is scarce. With very little data on infestations, it’s hard to know whether more inclusive policies have anything to do with isolated outbreaks.
The latest estimates of annual infestations in the U.S. are broad and unreliable since so many cases go unreported. The CDC puts the number between 6 million and 12 million, affecting mostly preschoolers and elementary-age children.
“It really is about education because there are so many myths and so many misunderstandings about lice out there,” said Cathryn Smith of the National Association of School Nurses chapter in Tennessee. “This isn’t a topic that most people talk about.”
NASN and the American Academy of Pediatrics have supported nonexclusionary head lice management since at least 2002. But the recommendations were taken more seriously after the covid-19 pandemic affirmed the importance of face-to-face schooling.
“I think that people are starting to realize the value of in-person school and that really anything that takes them out of that should be scrutinized,” pediatrician Dawn Nolt of Oregon Health & Science University told NPR and KFF Health News. “Head lice is not a valid reason to keep a kid out of school or be dismissed from school.”
Nolt co-authored the latest guidance issued by the AAP in 2022, which incorporated new research but largely echoed prior recommendations. It discourages widespread lice checks in schools, as a study published in the Pediatric Infectious Disease Journal found that lice are frequently misidentified, which leads to unnecessary treatment and isolation of lice-free children.
It takes four to six weeks for lice to go from nits to a full-blown infestation. Only then would a child be seen head-scratching uncontrollably, caused by an allergic reaction to the parasites’ saliva.
“Kicking them out on a Wednesday when they’ve been having it for the past four to six weeks is not going to do anything. But it’s going to take that kid out of school and shame that kid and shame that family,” Nolt said. “I just think that’s not acceptable.”
Inclusion is the priority, even if it may inconvenience others or sow financial costs. Over-the-counter remedies, such as creams, gels, or shampoos, can add up. Professional treatment, which often involves manually picking out lice and nits, can run into the hundreds of dollars per person. And sometimes lice hits an entire household.
This summer, a preschool outside Nashville, Tennessee, endured its biggest outbreak yet. Roughly a third of the kids at the Creative Youth Enrichment Center ended up with lice.
Owner Tonya Bryson knew the latest recommendations were to play it cool. So she kept everyone in school, and they faced the dreaded four-letter word together. And then she talked openly about the experience.
“It’s not as bad as you think it is,” Bryson said. “I mean, yes, we had quite a few kids with it, and it went to parents and siblings. But it’s manageable.”
Among the affected families was Stephanie Buck, who also teaches at the day care. Lice ran through her household, requiring pricey treatments to rid them all of the infestation.
Buck said she’s torn about the best approach to combat lice, balancing the shame and stigma with the practical matter of containing an outbreak.
“Because my daughter was really embarrassed when she found out that she was the first one who got checked and she had it,” Buck said. “It’s hard. You want to protect your babies’ hearts, but you also want to keep them from getting lice.”