When can a child return to school after being treated for pediculosis (head lice infestation)?

Return to School After Head Lice Treatment

Children can return to school immediately after receiving proper treatment for head lice, with no need for complete nit removal or a "no-nit" policy. 1, 2

Understanding Head Lice and School Attendance

The American Academy of Pediatrics (AAP) strongly recommends against excluding children from school due to head lice infestation. Key points to understand:

• Head lice have low contagion within classroom settings 1
• By the time lice are discovered, the child has likely had the infestation for a month or more 1
• "No-nit" policies (requiring complete removal of all nits before return to school) are not recommended and should be abandoned 1, 2, 3
• These policies are based on misinformation rather than scientific evidence 1

Management Protocol After Diagnosis

Day of Diagnosis:

1. Child should remain in class but be discouraged from close direct head contact with others 1
2. Notify parents/guardians that day (by phone or note sent home) 1
3. Begin appropriate treatment promptly

Return to School:

• Child can return to school immediately after proper treatment has been initiated 2
• No need to keep child home from school during the treatment period 1, 3
• No need for complete nit removal before returning to school 1, 2

Recommended Treatment Approach

First-line Treatment:

• Permethrin 1% cream rinse or shampoo 2, 3
  • Apply sufficient product to saturate hair and scalp
  • Pay special attention to back of head and neck
  • Leave on for exactly 10 minutes
  • A second application 7-10 days after first treatment is recommended to kill newly hatched lice 2

Alternative Treatments:

• For treatment failures: Malathion 0.5% or Ivermectin (for patients >15kg) 2
• Non-insecticidal options: Dimethicone, isopropyl myristate 3
• Wet combing with fine-toothed comb for those who prefer to avoid insecticides 2

Nit Removal Considerations

While complete nit removal is not necessary for school attendance, it may be beneficial for:

• Decreasing diagnostic confusion 1
• Reducing the possibility of unnecessary re-treatment 1
• Decreasing the small risk of self-reinfestation (particularly for nits within 1cm of scalp) 1

Common Pitfalls to Avoid

1. Unnecessary school exclusion: No child should miss valuable school time because of head lice 1
2. Misdiagnosis: Finding nits alone is not sufficient to diagnose active infestation; live lice must be present 2, 3
3. Overtreatment: Do not retreat prematurely or overuse pediculicides 2
4. Excessive environmental cleaning: Extensive environmental decontamination is not necessary 2, 3
5. Stigmatization: Head lice affect all socioeconomic groups and do not reflect poor hygiene 2

Follow-up Recommendations

• School nurse (if available) can recheck child's head if requested by parents 1
• Examine all household members and close contacts, treating concurrently if infested 4
• Check scalp 10 days after treatment to confirm success 5
• If live lice are still present after 10 days, consider switching to a product with a different active ingredient 5

By following these evidence-based guidelines, schools can minimize unnecessary absences while effectively managing head lice infestations.