Head lice infestations are common and not a public health concern. They spread through direct head-to-head contact and do not transmit disease. Effective treatment involves wet combing or bug busting to physically remove lice and nits. Schools play a role in prevention by providing information and support but should avoid policies that promote unnecessary treatment or exclude children. Public health aims to manage lice collaboratively through guidelines, resources, and supporting schools and families.

1. Jason K Easter
Health Promotion Officer
GHA Public Health Directorate
December 2012
Training for Health
Head Lice
In Childcare Settings

2. OVERVIEW
Intro & timeline1
Morphology2
The problem3
Prevention & Treatment4
The School Role6
Public Health Role5
The Role of the School Nurse7

3. Hunting lice by
candlelight
by Andries Both, 1630
(National Gallery, Budapest)

4. HEAD LICE EVOLVING
Genetic research of modern head lice
suggests that modern humans lived
alongside our ancient relatives Homo
erectus.
These distinct lineages of
modern head lice diverged
about 1.18 million years ago.
Early man had lice, ancient Egyptians
had lice, it was rife in the medieval
epoch and not much has changed to
date.
Intro & timeline1

5. WHAT ARE HEAD LICE ?
Morphology2

6. Pediculus humanus
morphology
Head Louse
Pediculus capitis De Geer, 1767
Tiny greyish brown in colour
Wingless insects
Adult is about 2mm in length
The size of a sesame seed
Restricted to the hair on the
scalp, particularly on the nape
and in the area behind the ears.
Not on the eyebrows or
eyelashes.
Does not “naturally” vector
disease
Killed no one
Currently not a Public Health
Concern

10. Head lice are not nits

11. NITS ARE:
 actually the empty egg cases of head lice
 remain weeks or even months after an infestation
NITS CAN:
 necessarily mean you have head lice – look for a living,
moving louse using the recommended detection method
NITS DO NOT:

12. How do we get head lice?
The problem3

13. HOW DO WE GET HEAD LICE?
 Head lice live in the hair, right next to
the scalp
 They live in any hair - clean or dirty,
long or short
 They cannot hop, fly or jump
 Head lice are spread through head to
head contact
The problem3

14.  Head lice can live on anyone - not just
children
 Many infestations are spread by
families and friends
 You are unlikely to catch head lice
from objects such as chair backs, hats
or towels
HOW DO WE GET HEAD LICE?
The problem3

15. Buenos Aires study on 5635 children:
The problem3

16. How can we tell if someone has lice?
The problem3

17. HOW CAN WE TELL IF SOMEONE HAS LICE?
 Some people will get an itchy scalp
But –
 You may not know you have head lice
 Detection combing is the best method of identifying
head lice
The problem3

18. BUG BUSTING THE ONLY RELIABLE WAY
Prevention & Treatment4

19. BUG BUSTING THE ONLY RELIABLE WAY
Prevention & Treatment4

20. BUG BUSTING METHOD
Prevention & Treatment4

21. OTHER TREATMENTS
Other options include:
 repeated wet combing over several weeks
 'electric combs'
 essential /aromatherapy oil preparations
 Head hoovers
Prevention & Treatment4

23. Prevention & Treatment4
OTHER TREATMENTS
None of these are supported by clinical
evidence to prove their effectiveness
in treating infestations

24. Public Health Role5
How Public Health Can Help

25. HOW PUBLIC HEALTH CAN HELP
Public Health Role5
 The Health Promotion Unit can advise on policy and
guidelines for managing head lice in schools.
 Involvement in producing information resources for the
community and supporting of school staff.
 With a collaborative association public health fosters a
community approach to managing head lice. The school
staff, parents and health specialists are members of a
strong and effective partnership.
School Exclusion policies are NOT supported by the Public Health Services

26. What do schools have to do with it?
The School Role6

27. WHAT DO SCHOOLS HAVE TO DO WITH IT?
 Head lice infestations are a community problem - not
just a school problem
But -
 Schools are at the 'frontline' as so many children are in
contact with each other
The School Role6

28.  Infestations can spread in the classroom - prolonged
head to head contact the cause .
 Break-time, lunch time and out of school play also help
the infestation to spread - children come into close
contact with each other.
 There is a low level of head lice infestation usually
present in the community.
 An 'outbreak' is unlikely to be as widespread as parents
may imagine.
 At any time, 2 - 5% of children in a school will have head
lice.
The School Role6
WHAT DO SCHOOLS HAVE TO DO WITH IT?

29.  Utilise the ‘Head Lice Management - for all educational
institutions’ document provided by the Public Health
Department – all schools will have a copy
 Provide support, advice and information as part of an
ongoing health initiative.
 The school nurse can advise on the causes and
treatment of head lice infestation .
The School Role6
WHAT CAN SCHOOLS DO?

30.  To ensure that locally approved policies are followed.
 To avoid promoting advice or action that is not locally approved.
 To work with the health services towards preventing ill-health and
minimising the effects of ill-health on school children and their
education.
 To disseminate information to schools in order that school staff are
aware of locally approved policies in connections with lice
infestations.
The School Role6
THE ROLE OF THE EDUCATION DEPARTMENT:

31.  To ensure that locally approved policies are followed within their
school.
 To avoid promoting advice or action that is not within the locally
approved policy.
 To inform the school nurse, in confidence, of cases of lice infestation.
 To assist the school nurse in disseminating advice to parents and pupils.
This should be an on-going.
 To support the school health service in any health promotion events
they wish to hold in school - Parents, pupils and staff should be
encouraged to attend.
 To guide concerned parents to the most appropriate agency for dealing
with their concerns.
 To maintain confidentiality of health information on children and
encourage the same in other staff.
The School Role6
THE ROLE OF THE HEADTEACHERS:

33.  To ensure that locally approved policies are followed.
 To avoid promoting advice or action that is not locally approved.
 To ensure that he/she is fully informed and up to date with current
knowledge and practice.
 To give consistent advice to parents, children and school staff and
make them aware of means of transmission and of current
treatment.
 To discourage unnecessary or inappropriate treatment.
The Role of the School Nurse7
THE ROLE OF THE SCHOOL NURSE:
The use of school nurse time to detect infestations has been discontinued for
some years because it has been shown to be ineffective in the control of
infestations.

34.  To ensure that locally approved policies are followed
 To avoid promoting advice or action that is not locally
approved
 To ensure that the school nurse designated for a school is
contactable during normal working hours by parents and the
school for information, advice and support
 To ensure that training programmes are in place to enable
staff concerned to be kept fully informed and up to date with
current knowledge and practice
 To encourage regular educational programmes by healthcare
staff in school for children, parents and staff
THE ROLE OF THE SCHOOL HEALTH SERVICE:
The Role of the School Nurse7

35. WHAT WE NEED TO REMEMBER!
 Infestations are not a health threat
 Infestations do not vector disease
 Detection and treatment are simple
 Schools should keep a child's identity confidential and
not use alert letters in an infestation.
 The school can provide ongoing support and information
 The school health nurses are available for help with
persistent cases and general advice/support.

36. CONCLUSION
Greater control and a possible eradication can only
happen if the world busts the bugs on the same day, at
the same time…
Otherwise:
Follow the protocol.