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Supplements Definitive Management of Head Lice in the Era of Pediculicide Resistance
Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Head Lice Treatment Costs and the Impact on Managed Care
Dennis P. West, PhD, FCCP
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
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Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Treating and Managing Head Lice: The School Nurse Perspective
Sally Z. Schoessler, BSN, RN, SNT
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
Currently Reading
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
Head Lice Treatment Costs and the Impact on Managed Care
Dennis P. West, PhD, FCCP
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD
Treating and Managing Head Lice: The School Nurse Perspective
Sally Z. Schoessler, BSN, RN, SNT

American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation

Barbara L. Frankowski, MD, MPH

The AAP is working with school nurses to discourage no-nit policies. Unfortunately, school nurses often are pressured by school administrators and parents to control infestations. The no-nit policies may appeal to laypersons, and it is difficult to explain why they are not effective, particularly when some consumer organizations strongly support them. Nevertheless, there is no scientific basis to confirm the effectiveness of such programs, but there is research supporting the view that the presence of nits poses only a slight risk. In a 2001 study conducted in 2 metropolitan elementary schools, 1729 children were screened for head lice. A total of 28 children (1.6%) had lice, and 63 (3.6%) had nits with no lice. After 14 days, 18% of children with nits alone developed lice. Researchers concluded that having 5 or more nits within 1/4 inch of the scalp increased the risk of conversion, but most children with nits and no lice did not become infested. The study also concluded that exclusionary policies for children with nits alone are excessive.10

Conclusion

Safe treatment of children with head lice infestation is the primary objective of the AAP. Unfortunately, overuse and inappropriate use of pediculicides may expose children to unnecessary risk and contribute to resistance. Several pediculicides are available to treat head lice infestation, but resistance has been documented for all products except malathion. Prescription products should be used conservatively and only under close supervision by a physician.

School measures that are designed to control infestations may in fact be detrimental. Specifically, no-nit policies result in lost time from school, inappropriate allocation of the school nurse's time for screening, which is often ineffective, and a response to infestations that is out of proportion to their medical significance. The AAP guidelines for control of head lice infestation include recommendations for accurate diagnosis, safe treatment options, and a common-sense approach to managing infestations in a school environment.




1. Frankowski BL, Weiner LB; Committee on School Health the Committee on Infectious Diseases. American Academy of Pediatrics. Head lice. Pediatrics. 2002;110:638-643.

2. Pollack RJ. Head lice information. Harvard School of Public Health. Available at: http://www.hsph.harvard. edu/headlice.html. Accessed on June 17, 2004.

3. Meinking T, Taplin D. Infestations. In: Pediatric Dermatology. 3rd ed. Schachner LA, Hansen RC, eds. Edinburgh: Mosby;2003:1141-1180.

4. Chunge RN, Scott FE, Underwood JE, Zavarella KJ. A review of the epidemiology, public health importance, treatment and control of head lice. Can J Public Health. 1991;82:196-200.

5. Treating Head Lice. Fact Sheet. Centers for Disease Control. Division of Parasitic Diseases. Available at: http://www.cdc.gov/ncidod/dpd/parasites/headlice/factsht_head_lice_treating.htm. Accessed on June 23, 2004.

6. FDA Public Health Advisory: Safety of Topical Lindane Products for the Treatment of Scabies and Lice. Center for Drug Evaluation and Research. Available at: http://www.fda.gov/cder/drug/infopage/lindane/default.htm. Accessed on June 23, 2003.

7. Meinking TL, Serrano L, Hard B, et al. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138:220-224.

8. Hansen RC, and Working Group on the Treatment of Resistant Pediculosis. Guidelines for the treatment of resistant pediculosis. Contemp Pediatr. 2000;17(suppl):1-10.

9. The No Nit Policy. National Pediculosis Association. Available at: http://www.headlice.org/downloads/nonitpolicy.htm. Accessed on June 23, 2004.

10. Williams LK, Reichert A, MacKenzie WR, Hightower AW, Blake PA. Lice, nits, and school policy. Pediatrics. 2001;107:1011-1015.

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