National guidance on managing head lice infection in children

National Guidance on Managing Head Lice Infection in Children

Annex 3 Head lice: notes and guidance for school nurses and health visitors in nurseries or other responsible school or nursery health officers

General

• Health professionals should be able to identify a louse at all stages of its development.

• Parents and staff should be made aware that head lice are only transmitted by direct,
  head to head contact.

Specific

• Routine head inspections should never be undertaken as a screening procedure. Detection combing should be done by parents, but it is important that you give them proper information, advice and support.

• Where possible stick to the following principles of control:

• definite diagnosis; a living, moving louse found by detection combing;

• listing and examination of contacts by the family;

• simultaneous thorough and adequate treatment of all confirmed cases;

• repeat of the same treatment after seven days or the use of the wet combing method, also known as 'bug busting' every 3 days for up to 3 weeks.

• Make a professional assessment of reported cases of head louse infection of any child in the school. If the report is from the child's parent, make sure that the parents are provided with information, advice and support. If the report is from a teacher, for example that the child is scratching continuously or that a moving louse has been seen on the head, it may be necessary to confidentially and sensitively inform the parents or carers of the child. If your knowledge of the parents or carers is good, it may be sufficient to make contact with them to ensure that they know how to undertake detection combing and what to do if there are head lice present.

• Do not diagnose head louse infection unless you yourself have seen a living, moving louse, or you have physical evidence from the parents; ask them to stick one of the lice on a piece of paper with clear sticky tape and bring it in to you or one of their other health advisors.

• Nurseries and other educational establishments should not issue "alert letters" to other parents/carers.

• Do issue regular updates to parents and carers, perhaps in newsletters, reminding them of their responsibility to check their children's hair at least once a week using the wet combing method.

• Familiarise yourself with the correct use of insecticidal lotions to be able to advise parents and carers.

• Make every effort to discourage unnecessary treatment with insecticides.

• Do not recommend re-treatment without first of all establishing that living, moving lice are still present after two applications of the same lotion seven days apart. Or if the family were using the wet combing method also known as 'bug busting', ensure they have repeated the process every 3 days for up to 3 weeks.

• Be prepared to do a home visit if that is the most tactful and effective way of dealing with a head lice problem within a family. You have the professional skills and training to educate, persuade, inform, guide and support them.

• The use of electronic combs, repellent sprays, or chemical agents not specifically licensed for the treatment of head louse infections should not be supported.

• You should play an active part in providing regular helpful and accurate information about head lice to parents and staff. This could be done in conjunction with other health professionals.

• Don't wait until there is a perceived major outbreak - a regular education programme rather than a reactive "campaign" is more sensible.

The 'Bug Buster Kit' is now available for prescribing by health professionals. Only one kit is required for a family and it is reusable. The kit, which includes an illustrated guide and combs, is available from some pharmacies and by mail order from:

Community Hygiene Concern (Charity reg no: 801371)
6 - 9 Manor Gardens
London
N7 6LA
Help Line: 020 7686 4321
Internet: www.chc.org

(This document has been adapted from appendix 3 of Head Lice: a Report for Consultants in Communicable Disease Control (CCDCs).)