Issues which often arise in relation to medical assessments at work.
What are head lice?
Head lice are tiny insects which live in the hair and feed by biting the scalp and sucking blood. The female head louse lays her eggs close to the scalp where it is warm enough to incubate them. The eggs, or nits, hatch out, start feeding and soon begin to lay more eggs. Empty egg shells are left attached to the hair when the louse hatches.
How are head lice transmitted?
Head lice cannot fly, jump or swim but spread by clambering from head to head.
They are caught by head-to-head contact with someone who already has them. Although anyone can catch them, they prefer the heads of four- to 11-year-olds. Clean hair is no protection against them. When heads touch, the lice simply walk from one head to another. Adult lice take every opportunity to exchange hosts to avoid extinction through in-breeding.
Shared brushes and combs can also transmit lice so schools should discourage children from sharing combs and brushes. It is also sensible for schools to stipulate that the school photographer should not use the same comb to tidy every child’s hair.
Shared hats, headphones and jackets hung close together do not, however, present a risk. This is because head lice that involuntarily fall off the head or clamber on to clothes or other articles, such as pillows or cuddly toys, are dying and harmless.
What are the signs of head lice infestation?
The way head lice feed causes itching, so scratching the scalp is usually the first sign that a child has head lice. It should be pointed out that the onset of itching may be delayed by weeks, or even months, when someone first catches lice. Another sign of head lice may be a rash on the base of the neck caused by lice droppings. Anyone who has had head lice for a while may begin to feel generally unwell or ‘lousy’.
How are head lice detected?
Lice are most easily detected by combing really well conditioned soaking wet hair with a fine-tooth comb. Really wet lice stay still and cannot escape. Combing dry or damp hair with a fine-tooth comb is not a reliable way to detect lice. In dry or damp hair, lice move quickly away from the disturbance caused by a comb. Regular head inspections in school, therefore, are of dubious value because only the most severe cases are likely to be detected. Many milder cases will be overlooked, thus lulling parents and schools into a false sense of security.
How are head lice treated?
There are two main methods of dealing with a head lice infestation: wet combing and use of insecticidal lotions. Whichever option is chosen, it is important to recognise that neither will protect against re-infection.
Use of insecticidal lotions
Do not use lotions unless live lice have been found. Check all close family/friends by the ‘wet combing’ method described below. If using a lotion, follow the instructions on the product packet and make sure you have enough lotion to treat all those who may be affected. The lotion used may be capable of killing eggs as well as lice, but there is no certainty of this. Check for baby lice hatching out from eggs three to five days after you use it and again at ten to 12 days. If the lice appear to be unaffected by the lotion or if the problem persists, you should take advice from your local school nurse, health visitor, pharmacist or GP. You should seek advice where whoever is being treated is under one year of age, suffers from asthma or allergies, or is pregnant or breast feeding.
Wet combing or ‘bug busting’ method
The ‘bug busting’ method is an alternative method, devised by the charity Community Hygiene Concern, which avoids the use of insecticides. It aims at systematic removal of live lice by combing through the hair and physically removing any lice found.
After washing the hair, copious amounts of conditioner should be applied and, after detangling with an ordinary wide-tooth comb. With the person sitting upright or leaning over the bath, comb the hair from the roots using a special ’bug buster’ fine-tooth comb, with the teeth of the comb slotting into the hair at the roots with every stroke. After each stroke, the lice should be cleared from the comb.
Wet lice find it difficult to escape from this combing. It is hard for them to keep a grip on hair which is slippery with conditioner, and so removal with the comb is easier. The lice should then be wiped on to kitchen paper and disposed of, or simply rinsed away.
This routine should be repeated every three to four days for two weeks so that any lice emerging from the eggs are removed before they can spread. Given that head lice do not lay eggs until about a week after they have hatched, it follows that removing the live lice regularly will result in lice-free children in a fortnight.
Re-infection can, of course, occur if head-to-head contact is subsequently made with someone with head lice. Bug buster kits, containing instruction leaflets, five combs (a de-tangler comb and combs for removing baby and adult live and empty shells) and a plastic cape, are re-usable, and are available from some local chemists or from Community Hygiene Concern.
What can schools do to prevent head lice?
Head lice infestation, particularly when repeated, can cause great distress. Schools may wish to consider the following approach to head lice prevention, which involves obtaining the co-operation of parents:
- Parents should be provided with information on bug busting.
- Schools may wish to supply parents with bug buster combs. Bulk buying can reduce the cost.
- Parents should be requested to check their child’s hair regularly, using the bug busting wet combing method described above, and inform the school as soon as they discover any head lice.
- If an outbreak occurs, all parents should be sent a standard letter, alerting them to the outbreak and asking them to take part in a bug busting campaign, involving careful combing of the whole family’s conditioned hair with a bug buster comb every three days over a two-week period. All parents should be asked to take part, regardless of whether they think their child has lice, since without rigorous checking the lice are easy to miss. Teachers and their families should also participate in the campaign.
- Parents who choose to use an insecticidal product should also be advised to bug bust three to five days after application, to check that no lice remain after the treatment and to clear any new lice which may be caught, before they multiply.
Dealing with cases of repeated infestation
The NEU sometimes receives enquiries about cases where particular children are known to be the source of regular re-infestation of other pupils, sometimes due to parental negligence or refusal to take the above steps to deal with their children’s own infestation. If, in such circumstances, NEU members feel that their school or employer is not taking the problem seriously, the union will offer advice and assistance.
As a general rule, the NEU does not favour excluding children with head lice from school in such circumstances. Excluding the child is unlikely to solve the problem and the child would suffer the stigma of exclusion for a reason beyond their control. Other contagious, but less noticeable, cases will probably remain. Exclusion is not used for other conditions with low transmissibility, such as verrucas and herpes simplex and, although unpleasant, head lice do not constitute a threat to public health.
Families with recurring or continuing infection need to be supported by health professionals, particularly school nurses. They should be prepared to make a professional assessment of reported cases, provide appropriate information, support and advice to teachers and parents, and undertake home visits if that is deemed to be the most tactful and effective method of dealing with the problems of a particular family.
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