PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1011-1015
Lice, Nits, and School Policy
Received May 31, 2000; accepted Sep 6, 2000.
,,
From the * Epidemic Intelligence Service, Division of Applied
Public Health Training, Epidemiology Program Office, Centers for
Disease Control and Prevention; Georgia Division of Public Health,
Department of Human Resources; and the § Division of Parasitic
Diseases, National Center for Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia.
Background. The epidemiology of head lice infestation is poorly understood. Many schools treat all children with nits as though they are contagious. Children with nits but no lice are often removed from school until they are treated and all visible nits are removed.
Objective. To investigate the probability that children with nits alone will become infested with lice.
Design. Prospective cohort study.
Setting. Two metropolitan Atlanta elementary schools.
Participants. A total of 1729 children were screened for head lice. Twenty-eight children (1.6%) had lice, whereas 63 (3.6%) had nits without lice. Fifty of the 63 children (79%) with nits alone completed follow-up.
Outcome Measure. Conversion (ie, becoming infested with lice) within 14 days after initial screening.
Results. Nine of 50 children (18.0%) followed for nits
alone converted. Although children who converted did not have
significantly more nits than did nonconverters, having nits near the
scalp was a risk factor for conversion. Seven of 22 children (31.8%)
with 
5 nits within one fourth inch of the scalp converted, compared with 2 of 28 children (7.1%) with fewer (relative risk: 4.45; 95%
confidence interval: 1.03-19.35). This risk remained statistically significant after separately stratifying for sex, recent treatment, and
total number of nits.
Conclusions. Although having 5 nits within one fourth
inch of the scalp was a risk factor for conversion, most children with
nits alone did not become infested. Policies requiring exclusion from
school and treatment for all children with nits alone are likely
excessive. Instead, these children may benefit from repeated
examination to exclude the presence of crawling lice.lice, pediculus, lice infestations, pediatrics, school.
.
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