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A Study Guide on Children's Health

Unit 6: Head Lice

How will this unit help me?

This unit will:

• develop your awareness of head lice as a communicable condition;
• increase your knowledge and understanding of the implications of this condition within a school context.

On completion of this unit, you will be able to:

• identify signs and symptoms;
• analyse procedures when dealing with a sensitive issue;
• evaluate methods of controlling head lice in a school environment.

Setting the scene

The facts about head lice

Head lice are tiny wingless parasitic insects which spend their whole life cycle on human head hair. Head lice have three pairs of legs ending in claws for grasping hairs. They are often not much bigger than a pinhead and rarely larger than a sesame seed. Head lice live on, or very close to, the scalp and draw blood from the skin. Nits are egg cases laid by lice, stuck to hair shafts. They are tiny (about the size of a sugar grain) white or dark and oval-shaped. Often there is no obvious indication of infection for several weeks. An early sign of infection is a rash which often appears at the base of the neck. Other indications that a child has head lice include:

• Intense itching of the scalp;
• Tiny red spots on the scalp;
• Nits seen at the base of the neck and around the ears.

Who catches lice?

Despite understandable anxiety amongst parents and teachers, public health experts advise that head lice should not be regarded as a major problem. In fact, according to one group of experts: 'The more serious problem is excessive public and professional reactions that lead to an inflated perception of prevalence, to unnecessary, inappropriate, or ineffective action and to unwarranted anxiety and distress' (Public Health Medicine Environmental Group, 1999).

Head lice are transmitted only by direct head to head contact. Most infections arise from contact between close friends and family, and transmission within the classroom is fairly rare. Teachers have an important role to play in countering myths about head lice and in providing parents with accurate information. Sometimes this will mean tactfully reassuring parents that there has not been a serious 'outbreak' and resisting suggestions that the school should send an 'alert letter' to homes when cases of head louse infection arise.

Treatment

Concerned parents should be encouraged to seek advice from the school nurse, family doctor or pharmacist. Teachers may have opportunities to provide factual information and pass on fact sheets, if appropriate. The conventional treatment involves using a lotion or shampoo containing an insecticide. Chemical treatments must be used carefully, following the instructions supplied. This method will kill live lice. The treatment may require to be repeated seven days later to kill lice which have hatched after the first application. Medical authorities advise against treatment with chemicals unless there is clear evidence that a living louse has been found. The method of 'detection combing' is explained in leaflets available from the school nurse, family doctor or pharmacist. Parents worried about the use of chemical treatments may prefer a 'natural' alternative. These typically involve regular checking with a special comb, sometimes in combination with shampoos or lotions containing oils or herbal extracts. These alternative methods will only be successful if conducted carefully, following advice.

Developing your understanding

Activity 1: Head lice - fact or myth?

In the list below, can you identify which statements are facts and which are myths? The correct answers are given at the end of this unit.

Fact	or Myth	Statements about Head Lice
		Nits and head lice are the same thing.
		Head lice just appear.
		Only people with clean hair get head lice.
		Having the hair cut short will prevent the spread of head lice.
		Only children catch head lice.
		Pets cannot pass on head lice.
		Washing with ordinary shampoo will prevent head lice.
		Regular washing with an insecticide shampoo will prevent head lice.
		Head lice products are harmful to humans.
		Infected pupils can continue to attend school.

[Reference: this activity is based on information provided in a leaflet, Information on head lice for parents and carers (Greater Glasgow Health Board, August 2000) and from Head Lice Explained by Community Hygiene Concern, 1998]

Activity 2: Brainstorm: Suggestions for inclusion in a school policy

Schools are recommended to have a written policy on the management of the head louse problem. What might be included in a policy? Using the headings below, brainstorm your ideas. You can then compare your ideas with the suggestions which follow. This could be a group activity if you are able to have a discussion with fellow-students. A commentary is provided at the end of the unit.

Headings

• Involving parents
• Using external agencies
• Ensuring confidentiality
• Immediate action by the school

What would you do? Situation 1

It is 08.45 and you are in the school playground on the way into school. The parent of a child in your class approaches you and asks to speak to you privately. The parent explains tearfully that her child has head lice and has been kept at home, looked after by a relative. She is obviously extremely embarrassed about what has happened and the word 'shame' is used. There has been a telephone call from the parent of another child who, somehow, has heard of the 'outbreak'. This parent has apparently demanded that the infected child be excluded from school and said that the school should be informing all parents of the risk of infection.

How might the school handle these connected incidents? How might you support the child on return to your class (consider bullying etc.)? A commentary is provided at the end of the unit.

Want to know more?

The following are considered useful background reading and references for students involved in initial teacher education. They are not intended as recommendations for classroom use

Further reading and other sources of support

http://www.kidshealth.org

An information leaflet on symptoms

http://www.phls.co.uk

A fact sheet for schools

http://www.nits.net

Community Hygiene Concern site

http://www.nlm.nih.gov/medlineplus/headlice.html

A health information site covering a range of issues

Irvine, S. (1997) A Guide to Child Health in the Primary School. Edinburgh: Health Education Board for Scotland.

Community Hygiene Concern
160 Inderwick Road
London. N8 9JT

Bugbuster hot line: 0181 341 7167

Answers

Activity 1: Head lice - fact or myth?

Statements about Head Lice

Activity 2: Suggestions for inclusion in a school policy

• Involving parents
  • Agreed procedure for contacting parents
  • Guidance on preventing spread of alarm among parents, teachers and children (Letters sent to all parents in a class or school on the basis of one child's infection are misguided and can lead to panic.)
  • Ways of communicating with parents (e.g. seminars, leaflet)
• Using external agencies
  • Refer to guidelines issued by the local health board and council education department.
  • Collaboration with school nurse
  • Suggested sources of information, e.g. GP practice nurse or pharmacist
• Ensuring confidentiality
  • Ways of observing confidentiality
  • Reference to guidelines on working with children
• Immediate action by the school
  • Procedures for enabling child to remain in school, e.g. once treatment has been started child should not be excluded
  • Ways of ensuring child is not targeted or identified by others

Commentary

What would you do : Situation 1

You have a duty to keep within school and council policy. However, you should recognise the sensitivity of the situation and work towards avoiding confrontation with either parent.

• At the time, reassure the parent of the infected child that this is something that can happen to anyone. One means of reassurance is to provide a leaflet explaining the condition and how the parent can help. You could also recommend other sources of help, e.g. the school nurse, GP practice nurse, pharmacist or local health promotion department.
• Explain school and council policies clearly - once the child has started treatment he/she can return to school.
• While the head teacher is likely to take action, you have a responsibility to support the child. Consider ways of involving the child in classroom activities to boost self-esteem.

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