Pollack, Kiszewski and Spielman present some important data documenting the overdiagnosis of head louse infestations in school age children. They state that the major pitfall is inability of diagnosticians to differentiate active manifestations from extinct infestations and noninfestations resulting in overtreatment and unnecessary exclusions from school.
Although their recommendations to assure accurate diagnosis are ideal they are, for most schools, impractical: “Diagnosis of pediculosis should be based on microscopic examination of specimens… .” In our district, with 218 school campuses, we could not justify the expense of microscopes for each campus. Neither would it be feasible for most school districts to send multiple samples to a laboratory for confirmation; the cost would be prohibitive. Our nurses use a strong light source and a hand-held magnifier for screening.
I agree that parent volunteers should not be given the task of diagnosing pediculosis. School nurses are the logical ones for screening and triage or dispensing treatment if they have received formal instruction in identifying lice and their eggs. Schools without school nurses have a real dilemma.
Certainly mass school exclusions and “no nits” policies are of little use. After diagnosis of pediculosis is made in a child, Dallas schools dispense enough pediculocide to treat all family members. This obviates the need for exclusion from school. We use exclusions only for the small number of families who appear to have chronic infestations and then make every effort to determine the cause of “chronic infestations”: (1) misdiagnosis; (2) noncompliance with treatment protocol; (3) new infestation; and (4) nonovicidal treatment.
Finally, despite the benign nature of pediculosis, public school officials must respond to parent concerns and deal decisively with outbreaks or risk credibility problems or negative media exposure, all of which disrupt the educational process.