School nurse head lice toolkit: letters, notices, checklist and policy templates

[School letterhead]
[Date]

Dear families of [class or grade],

A case of head lice has been confirmed in your child's [class or grade]. Head lice are common in school age children, they do not spread disease, and having them has nothing to do with how clean a child or home is. We are letting you know so you can check your child at home this week.

How to check (about ten minutes)

Wet the hair, add plenty of conditioner, and comb from the scalp to the ends in small sections with a fine toothed metal lice comb. Wipe the comb on a white paper towel after each pass. Look closely behind the ears and at the back of the neck under good light. A live louse is tan or gray, about the size of a sesame seed, and moves. Nits (eggs) are tiny tan ovals glued to a single hair within about a quarter inch of the scalp; unlike dandruff, they will not slide or flick off.

If you find live lice or nits close to the scalp

Treat your child with a lice treatment, following the package directions, and comb out nits. Check everyone else in the household and treat only those who have lice. Wash hats, pillowcases and towels used in the last two days in hot water and dry on high heat; items that cannot be washed can be sealed in a bag for two weeks. Pesticide sprays for the home are not needed. Most treatments call for a second application 7 to 10 days later; please do not skip it.

If you find nothing

No treatment is needed. Please recheck every two to three days for the next two weeks, since an exposure can take time to show.

School attendance

Following the American Academy of Pediatrics and the CDC, [School name] does not send children home for head lice and does not exclude children who have nits. A child found to have lice may finish the school day, should be treated at home that evening, and may return the next morning once treatment has begun. We ask that you let the school nurse know if your child is being treated so we can keep an eye on the class, and we keep that information confidential.

Questions

Please contact the school nurse at [phone or email]. Reliable information is available from the CDC at cdc.gov/lice and from the American Academy of Pediatrics at healthychildren.org. [Optional: an evidence ranking of over the counter and prescription treatments, including which ones most US lice now resist, is at gocartwheel.com/pages/best-lice-treatment.]

Thank you for checking at home. It is the single most effective thing families can do to keep lice from spreading.

Sincerely,
[Name], [School nurse or principal]

Head lice have been found in [class or grade]. Please check your child's hair this week.

Lice are common in children, do not spread disease, and are not a sign of poor hygiene.

To check: wet hair, add conditioner, comb from scalp to ends with a fine metal lice comb, wiping the comb on a white paper towel. Look behind the ears and at the nape of the neck. Lice are sesame seed sized and move. Nits are tiny tan ovals stuck to the hair close to the scalp that do not flick off. Flakes that slide off are not nits.

If you find lice or nits close to the scalp: treat with a lice treatment per the package directions, comb out nits, check the rest of the household, wash recent bedding and hats in hot water, and repeat the treatment when the label says (usually 7 to 10 days later).

If you find nothing: no treatment is needed. Recheck every few days for two weeks.

Children are not sent home or kept out of school for lice or nits. Please tell the school nurse if your child is being treated; we keep it confidential.

School nurse: [name, phone or email]. More information: cdc.gov/lice.

Student name: ______________________ Class or grade: __________

Date live lice or nits close to the scalp were found: __________

First treatment date: __________ Product or method used (optional): ______________________

Nits combed out: [ ] Yes [ ] In progress

Planned second treatment date (usually 7 to 10 days after the first): __________

Other household members checked: [ ] Yes [ ] Not yet

I confirm that treatment for head lice has begun and that I will complete the second treatment if the product directions call for one.

Parent or guardian signature: ______________________ Date: __________

Phone or email for the nurse to reach you: ______________________

School nurse section (optional): Recheck date __________ Live lice seen: [ ] No [ ] Yes Nits only: [ ] No [ ] Yes Notes: ______________________

Policy reminder for staff: under American Academy of Pediatrics and CDC guidance a child may return to school once treatment has begun. The presence of nits alone is not a reason to exclude a child or to require a recheck before return.

For checking one student who has symptoms or a reported exposure. Routine whole class screening is not recommended by the AAP.

Before you start

• Fine toothed metal lice comb, disposable gloves, white paper towels, good light, magnifier or phone camera, applicator sticks or a comb for parting hair.
• Private space. Head lice checks are done one student at a time, never in front of classmates.
• Reason for the check documented: symptoms reported, exposure reported, parent request.

Technique

• Part dry hair in one inch sections, starting at the nape of the neck and behind the ears, then the crown.
• Look for live lice (tan or gray, sesame seed sized, moving) and for nits glued to a single hair shaft within a quarter inch of the scalp.
• Try to move anything you find. A nit will not slide along the hair; dandruff, hair casts and product flakes will.
• If uncertain, pull a hair with the specimen on it and look under magnification, or photograph it next to a coin.
• Combing wet hair with conditioner and a metal comb over a white paper towel is more sensitive than visual inspection alone when time allows.

What counts as an active case

• A live louse: active infestation.
• Nits within a quarter inch of the scalp in a child who has not been treated in the last month: treat as active.
• Nits more than a quarter inch from the scalp only: almost always hatched or dead; not an active case on its own. Advise a recheck at home in two to three days.
• Itching alone, flakes, or a classmate's case: not a diagnosis.

If lice are found

• Call the parent or guardian privately. Explain what was found, that the child may finish the school day, that treatment should start at home that evening, and that the child may return the next morning.
• Give or send the parent notification letter and the treatment confirmation note from this toolkit.
• Advise checking everyone in the household and treating only those with lice.
• Advise the second treatment 7 to 10 days later if the product directions call for it.
• Do not identify the student to other families. Classroom notices name the class, never the child.

Documentation

• Date, reason for check, findings (live lice, nits and their distance from the scalp, or none), parent contact made, materials sent home, planned recheck if any.
• Keep records confidential and separate from general attendance notes.

What not to do

• Do not send the child home early. Do not exclude for nits. Do not require a nurse recheck before return. Do not screen whole classes routinely. Do not recommend treating children who have no lice or no nits near the scalp.

• Head lice do not spread disease and are not a public health hazard. Infestations are common in children aged 3 to 11, spread mainly by direct head to head contact, and have nothing to do with hygiene. (CDC)
• The American Academy of Pediatrics 2022 clinical report states that no healthy child should be excluded from or miss school because of head lice, and that no nit policies should be abandoned. (Nolt et al., Pediatrics 2022)
• The CDC says students with head lice do not need to be sent home early; they can go home at the end of the day, be treated, and return after treatment begins. (CDC)
• Routine classroom or school wide screening has not been shown to reduce infestations and is not recommended. Checks are done privately, one child at a time, when there are symptoms or a known exposure. (AAP)
• Nits alone, especially those more than a quarter inch from the scalp, do not indicate an active infestation. Diagnosis requires a live louse or nits close to the scalp. (CDC, AAP)
• No nit policies cause missed school days, lost work for parents and stigma for children without reducing transmission. (AAP)

Suggested policy language

1. A student found to have live head lice may remain in school until the end of the day. The school nurse will notify the parent or guardian privately and provide information on treatment.
2. The student may return to school the next day once treatment has begun. A note confirming treatment may be requested but a nurse recheck is not required for return.
3. The presence of nits alone is not grounds for exclusion from school.
4. The school does not conduct routine mass screening. Individual checks are performed by the school nurse when a student has symptoms or a reported exposure.
5. The identity of a student with head lice is confidential. Classroom notifications name the class, never the student.
6. Families receive written guidance on how to check at home, how to treat, and the second treatment most products require 7 to 10 days later.