Letter to the Editor by Lauren Barnaby-Monsour to OJIN topic: “Back to Class: Perspectives on School Nursing”

Back to Class: Perspectives on School Nursing

December 17, 2021

Response by Lauren Barnaby-Monsour to OJIN topic: “Back to Class: Perspectives on School Nursing

Dear Editor,

I am writing in regard to the OJIN topic, Back to Class: Perspectives on School Nursing. My question: “Why is there not a universal policy on how to manage head lice in our schools?” As a school nurse, I find the variability in how schools manage head lice frustrating. According to the Centers for Disease Control and Prevention (CDC), head lice is estimated to affect anywhere from 6 to 12 million children aged 3-11 years annually (Centers for Disease Control and Prevention, 2019). School policies on handling head lice cases vary from district to district, though clear guidance has been issued by the American Academy of Pediatrics (AAP) and the CDC. AAP’s Council on School Health advises that students should not miss class time because of head lice or nits (Devore, Schutze, & AAP Council on School Health and Committee on Infectious Diseases, 2015) The CDC (2015) states that students should not be dismissed early due to head lice. While neither of these organizations are regulatory of school district policies, the information and education they provide on this topic should be taken into consideration when school boards and health departments are determining head lice policies.

Policies that require the exclusion of students from school in any form when lice or nits are present, have far-reaching negative implications in addition to the disruption of their education. These policies make it difficult to maintain student privacy and confidentiality and can worsen the effects felt from the social stigma associated with head lice, causing undue stress on the student and the caregiver (National Association of School Nurses [NASN], 2020). I recognize that this topic poses as a public relations dilemma for some districts. Districts must make policy decisions while considering how they will be received by the parents and the community. There is a stigma that exists surrounding head lice that influences parent/caregiver and even teacher/administrator thoughts and beliefs. Head lice is more of a nuisance and has not been proven to spread disease. Instead of implementing policies that require students to be excluded, why don’t schools follow evidence-based guidelines? Why don’t schools come together and eliminate policies that require exclusion? Elimination of these policies is supported by evidence and expert guidance. These policy changes should be coupled with education to the students, parents, school staff and community. Education should include head lice prevention, facts vs. myths, how to perform routine head checks for parents, what to do if head lice are found, and how to access to evidence-based resources.

Our nation’s students have already lost too much precious time in the classroom due to the current Covid-19 pandemic. When students are able to safely return to school, any barriers that would cause them to miss any further critical, instructional time in the classroom, must be minimized. Schools need to adopt and implement policies aligned with the recommendations of the expert professional organizations and national public health institutes. The students’ best interest should be at the core of all decisions.


Lauren Barnaby-Monsour, ASN, RN
Excelsior College RN BSN Student


Centers for Disease Control and Prevention. (2019). Epidemiology & risk factors. Parasites. Retrieved from https://www.cdc.gov/parasites/lice/head/epi.html

Centers for Disease Control and Prevention. (2015). Head Lice Information for School. Parasites. Retrieved from https://www.cdc.gov/parasites/lice/head/schools.html

Devore, C., Schutze, G., & The AAP Council on School Health and Committee on Infectious Diseases. (2015). Head lice. Pediatrics, 135(5), e1355-1365. https://doi.org/10.1542/peds.2015-0746

National Association of School Nurses. (2020). Head lice management in the school setting. NASN [Position Statement]. Retrieved from: https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-head-lice