Supplements Definitive Management of Head Lice in the Era of Pediculicide Resistance
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
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
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
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.