• Barnstable Public Schools
    Office of the School Nurse

    Head Lice Protocol for the Management of the Student with Head Lice
    updated 11/10/16

    School Nurses will periodically remind and educate parents (newsletters, student handbook, brochures) on the importance of informing their child’s School Nurse if their child has head lice, been exposed to a contagious disease, or other changes in health status.

    Students enrolled in the Barnstable Public Schools who are discovered to have an active case of head lice (nits or lice) during school hours will be promptly identified and the following actions taken.

    The School Nurse will examine the student’s head for lice and nits. If live lice or nits are found, the student may return to class for the remainder of the school day based on nursing discretion. The student should be discouraged from close direct head contact with others. The student may be dismissed if the School Nurse’s assessment indicates that the student is uncomfortable due to thes everity of the infestation. The school nurse will contact the parent/guardian after identification of head lice or nits and will request prompt, proper treatment of their child’s head lice. The School Nurse will re-examine the student the next day or when they return to school.

    If a student is dismissed from school, the School Nurse will re-examine the student upon returning to determine the initial success of the recommended treatment. Students may attend class regardless of the presence of lice/nits based on nurse’s discretion. If the infestation is unchanged, the School Nurse may request that the parent/guardian come into the Health Office for instruction on identification and removal of nits/lice.

    Information regarding head lice and its treatment will be provided to the parents/guardians of all students found to have head lice or nits.

    If a cluster of cases are discovered in the same classroom, a general informational notice regarding lice may be sent home to the parents/guardians of the students in the classroom based on nursing discretion.

    Protocol review and revision by the School Physician Consultant and Nursing & Wellness Coordinator shall occur as needed, but at least every two years.

    Center for Disease Control and Prevention (2010). Head Lice Information for Schools. http://www.cdc.gov/parasites/lice/head/schools.html. November 2, 2010. Frankowski, B., Bocchini, J. (2010).
    Clinical Report – Head Lice. http://pediatrics.aappublications.org/content/126/2/392.full. July 26, 2010.
    National Association of School Nurses (2011). Pediculosis Management in the School Setting – Position Statement. http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/

    Protocol review and revision by the School Physician Consultant and Nursing & Wellness Coordinator shall occur as needed, but at least every two years.

    ________________________________ (School Physician Signature) __________________ (date)

    ________________________________ (Nursing & Wellness Coordinator Signature) ______________ (date)


  • Barnstable Public Schools
    Office of the School Nurse

    Head Lice Information for Parents/Guardians
    updated 11/10/16

    Head lice are a bothersome issue for students, parents and the school community in general. It is important to know that head lice are neither a health hazard, nor are they a sign of uncleanliness, and are not responsible for the spread of any disease.

    Your school nurse will work with you and your child should head lice or nits be identified upon examination either at home or in school. Remember: the school nurse can only be of assistance and support, when informed of the infestation. Below is information to help you understand the life cycle of the head louse and the steps you can take to relieve an infestation and prevent re-infestation.

    What Are Head Lice and How Are They Spread?

    Head lice are tiny wingless insects that feed on the human scalp. The eggs of head lice are called nits. Head lice crawl very quickly, but do not fly or jump. Head lice are spread primarily by direct head-to-head contact, and also from sharing personal items such as combs, brushes and other hair accessories. Sleep-overs among friends and relatives are thought to be the most common method of spreading infestations.

    How Do I Know If My Child Has Head Lice?

    If you observe your child scratching his/her head, that could be a sign of possible infestation. If parents of friends have notified you that their child has head lice, you should check your child. Your child’s school nurse may notify you as well, after a thorough head/scalp examination.

    What Is The Best Way To Look For Head Lice?

    Examine your child’s head under a bright light or near a sunny window. Examine small areas at a time (about 1 inch) by parting the hair with a comb. Look for eggs (nits) that look like dandruff, but are difficult to remove. Hatched eggs are whitish to sandy color; intact eggs are harder to see and more tan in color. Both will be seen on the hair shaft within an inch of the scalp. Both are extremely small; a magnifying glass can help, particularly if your child has light-colored hair. Adult lice travel so quickly that they are difficult to see.

    How Do I Remove The Head Lice?

    First, kill the lice.

    • Use a lice killing shampoo product. Consult your pharmacist or child’s physician to determine the best treatment for your child. Carefully follow the directions listed on the product label.
    • Using the fine tooth comb that comes with the shampoo product, comb the hair thoroughly. It is best to do small sections at a time to remove all visible lice and eggs. Although tedious, this is a very important step and should not be rushed.
    • Note: Be aware that some head lice have become resistant to common over-the-counter (OTC) preparations containing Permethrin: part of the pyrethroid class of insecticides. Consider choosing, a product containing ivermectin, malathion, and spinosad. Check with your physician since these
      products may require a prescription. While prescription preparations may be more costly than OTC preparations, they can be more effective and save time and money by not having to retreat the infestation.

    Next, re-inspect the hair.

    • If nits are still seen on the hair strands a solution of water and white vinegar may help loosen the nit “glue”. Once this is applied, recomb the hair in the same fashion: using the fine tooth comb, comb thoroughly small sections at a time.
    • Some nits may still be attached and need to be removed individually by pulling them down and off the hair strand using your fingertips.
    • Removing nits is very time consuming. Recombing with the fine tooth comb may need to continue daily
      for up to 4 weeks.

    Next, clean the house and belongings.

    • Clean the house and belongings
    • Concentrate on areas of the house and belongings the child uses the most (bedroom, coats, hats, bed linens)
    • Machine wash all washable items in hot water and dry in a hot dryer. These items include clothing, jackets & hats, bed linens and towels.
    • Place non-washable articles (e.g. stuffed animals) in a sealed plastic bag for approximately 2 weeks or send to the dry cleaners.
    • Soak combs and brushes in hot water or clean with lice killing shampoo.
    • Vacuum rugs, upholstered furniture, mattresses, etc. Seal and throw away the vacuum bags when finished.


    • Hair should be rechecked daily for the next 7– 10 days, the life cycle of head lice, to make sure the hair is free of head lice and reinfestation has not occurred.
    • If reinfestation has occurred, retreat according to the product directions.


    When Can My Child Return To School?

    The most current research indicates that it is not necessary to keep a child with head lice out of school. No diseases are associated with head lice and in-school transmission is considered to be rare. Students may attend class regardless of the presence of lice or nits. However, students may be dismissed from school if the nurse’s assessment indicates that the student is uncomfortable due to the severity of the infestation.

    As soon as the shampoo treatment has been done and you have removed all lice and as many nits as possible, your child can return to school. Your child should report to the health office the next morning so that the school nurse can examine and assess need for further treatment. If nits are still present, the nurse will work with you and offer recommendations on additional treatment and nit removal.