How soon can a child with pediculosis (lice) return to school after treatment?

Return to School After Head Lice Treatment

A child treated for head lice can return to school immediately after initiating treatment, even if nits are still present. 1

Evidence-Based Recommendations

The American Academy of Pediatrics (AAP) and the National Association of School Nurses explicitly recommend against "no-nit" policies that prevent children from returning to school until all nits are removed. These policies are not supported by scientific evidence and unnecessarily keep children out of school 2, 1.

Key points regarding school attendance:

• A child with head lice has likely had the infestation for a month or more before discovery and poses little risk to others 1
• Head lice have low contagion within classroom settings 2
• Only 31% of children with nits have concurrent live lice 1
• Only 18% of those with nits alone develop an active infestation during 14 days of observation 2

Management on Day of Diagnosis

When a 5-year-old is diagnosed with head lice:

1. The child should remain in class but be discouraged from close direct head contact with others 2
2. Parents should be notified that day (by phone or note sent home)
3. Confidentiality must be maintained to avoid stigmatization 1
4. Treatment should be initiated promptly

Proper Treatment Approach

First-line treatment is permethrin 1% lotion or shampoo 1, 3:

• Apply sufficient product to saturate hair and scalp
• Leave on for exactly 10 minutes
• A second application is recommended 7-10 days after the first treatment

Additional measures:

• Check all household members for head lice
• Treat only those with live lice or eggs within 1 cm of the scalp 1
• Use a louse comb to remove lice and nits (this improves treatment efficacy) 4

Common Pitfalls to Avoid

1. Unnecessary school exclusion: Keeping children out of school after treatment has begun is not supported by evidence 1
2. Overdiagnosis: Finding nits alone indicates a historical infestation, not necessarily an active one 3, 5
3. Environmental overreaction: Extensive environmental decontamination is unnecessary; focus on treating the affected individual 1, 5
4. Stigmatization: The child should not be made to feel responsible for having lice 4

Role of School Nurses

School nurses can provide valuable services by:

• Rechecking a child's head if requested by parents
• Offering extra help to families of children with chronic infestations
• Providing accurate information about diagnosis, treatment, and prevention 1

In rare instances, home visits or involvement of public health nurses may be helpful to ensure effective treatment for families struggling with persistent infestations 2.