Schools weigh attendance against risk of spreading lice
Yvette Forrest takes an extra 20 minutes braiding and oiling her daughter’s hair before she drops her off at Kamalii Elementary School.
The daily routine is a burden on the single mother, but she said it is necessary after her daughter came home with two small head lice eggs last month.
“I’m very strict with my daughter. One little egg grosses me out,” Forrest said Tuesday.
Forrest’s 2nd-grade daughter was not the only student to return home recently with an unwelcome guest. Several children at the South Maui school had their heads infested by the parasitic insect. Parents have criticized school officials for their lenient head lice policies, but research and medical professionals say otherwise.
Head lice, known as uku in Hawaii, infest millions of Americans every day and are most commonly found in children ages 3 to 12 years old. Head lice are not a health hazard or a sign of poor hygiene, and do not transmit any diseases, according to the American Academy of Pediatrics.
The state Department of Education has no universal policy regarding head lice in public schools, officials said.
Although the department advises schools to adhere to guidelines listed on the Centers for Disease Control and Prevention website, schools are free to implement their own policies.
Many schools in Hawaii have used “no-nit,” or no lice egg, policies for years. Schools typically remove a student immediately after active head lice or nits are found. Students cannot return to school until they’re clear of nits and head lice.
Kamalii Elementary School, under Principal Kim Mukai-Otani, has implemented a more lenient rule in recent years. At Kamalii, students may return to class as long as there are no active head lice or live nits; empty eggs are allowed.
Mukai-Otani said she looked to the DOE, CDC and state Department of Health to decide on her school’s policy. She opposes allowing live head lice in schools, but “the questionable part comes into treatment, nits and student return time.”
“I’m trying to make it the best situation for the students so they have optimal learning opportunities,” she said.
Students with active head lice or nits are sent home and their families are notified under the school’s policy, Mukai-Otani said. She said students can return to class once the school nurse and an administrator review the child’s head and parents prove they treated their child.
The thought of nits, alive or not, in children’s hair does not sit well with Forrest. She claims that some students still have live nits on their scalp and could “hatch at any moment and get on everyone.”
“There should be no eggs allowed in school,,” she said. “It’s ridiculous. It’s so not right.”
Forrest said she was notified of the uku outbreak via a school letter March 23 and immediately took her daughter out of class. She said students involved in the outbreak were allowed to stay in school despite having eggs in their hair and that she kept her daughter out of school for a week.
“I didn’t have a choice. My daughter’s health is most important,” she said.
Another parent, who declined to be identified, had to pull her 2nd-grade daughter out of school after she found the grayish-white insect crawling freely throughout her daughter’s hair.
“It was horrible,” she said. “I had to go to the store to buy the really strong stuff. It’s expensive. It’s not cheap. And this affects everyone in the family so I had to buy a box for myself as well and had to treat everybody.
“What was sad was, two weeks after I treated her, her hair fell out on the front of her hair line.”
The parent said she goes through every strand of her daughter’s hair because one or two nits leftover could reinfect the scalp. She added that she has been washing bedsheets and spraying furniture for a month to ensure she kills off the pesky insect from her home.
“It’s gotten out of control at the school, and if somebody wants to pay for the products for me and hire a maid, then fine, just keep reinfesting,” she said. “But I really refuse to keep putting that poison in my daughter’s hair. I mean, her hair fell out.”
Jayme Tamaki, a state Health Department public health supervisor who serves as a consultant to public and private schools in Maui County, said head lice policies are difficult to establish considering the importance of school attendance. She also noted the embarrassment and stigma that comes with being infested with uku and advises all health aides to notify parents and teachers of an outbreak without targeting specific students.
“We don’t recommend isolating children, but yet you still have to think about the other kids,” she said.
Tamaki said some families cannot afford treatments and may not have time to do thorough cleanings. She said she has made home visits to help families and tries to provide as much education as possible.
While the Health Department does not have a universal head lice policy, all school health aides are recommended to follow a manual from the department. The manual calls for health aides to check students who had been sent home for head lice, three consecutive school days before taking into account their school’s policy and clearing them for classes. If the student fails any of the days, they must restart the process, Tamaki said.
It remained unclear why the Health Department does not have a universal head lice policy for schools, but officials said they are updating their School Health Aide Manual, and expect it to be completed this summer. Officials said the manual will closely align with CDC guidance, which steers toward a much more lenient policy.
According to the CDC, students with live head lice do not need to be sent home early from school. Rather, they can go home at the end of the day, be treated and return to class after appropriate treatment has begun.
Schools across the nation are starting to kick the “no-nit” policy, and major health associations have called for stopping it. Both the American Association of Pediatrics and the National Association of School Nurses have advocated against the policy because:
* Many nits are more than a quarter of an inch from the scalp, usually not viable and very unlikely to hatch to become crawling lice. They may also be empty eggs.
* Nits are cemented to hair shafts and are very unlikely to be transferred to others.
* Unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
* Misidentification of nits is very common during checks conducted by nonmedical personnel.
Dr. Kathryn Edwards, section chief of pediatrics at Kaiser Maui Lani, said Saturday that pediatricians have been saying for generations that “no-nit” policies offer little in controlling head lice infestations. She said head lice “just make people squirm.”
“It’s very frustrating because schools will send students home over and over again,” Edwards said. “It’s hard to get them to change their policy because there’s such an emotional reaction to head lice.”
Bernice Takahata, principal at Pomaikai Elementary School in Kahului, said that her school evaluates students case by case, but generally follows a “no-nit” policy. She said it becomes a balancing act of keeping students in school but eliminating infestations as quickly as possible.
“It’s education verse eradication,” Takahata said.
Mukai-Otani said that Kamalii Elementary School continues to review its head lice policy but would like the DOE to implement a universal policy to help with “consistency” among schools.
“It’s hard when it’s left up to individual schools, and everybody is coming from different sides,” she said.
Forrest said she only wants her daughter to be uku-free.
“I’m crossing my fingers that she doesn’t come home with anything,” she said.
* Chris Sugidono can be reached at email@example.com.