The Journal of School Nursing2025, Vol. 41(5) 650–651© The Author(s) 2025Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405251360798journals.sagepub.com/home/jsn
It is the position of the National Association of School Nurses to support evidence-based, nonexclusionary head lice management policies and practices in the school setting. Professional registered nurses (RNs), hereinafter referred to as school nurses, are leaders who bridge healthcare, education, and public health and advocate for head lice management strategies that promote equitable, positive health, and academic outcomes for all students.
Cases of human head lice (pediculosis capitis) are a common communicable condition that can cause itching and affect individuals across all socioeconomic levels. While head lice are a nuisance, they are not known to cause or transmit illness or disease and do not constitute a health hazard (Guenther, 2023). Early dismissal or exclusion from school for the presence of live head lice or nits (lice egg cases) is unnecessary. These practices lack scientific evidence of effectiveness in reducing the course or spread of head lice (Nolt et al., 2022).
A student identified with live head lice should remain in school until dismissal time. The possibility of transmission to others for the remainder of a school day poses little additional risk since an individual presenting in school with lice has likely been affected for days prior to the identification. The school nurse should notify the family of the affected student and advise the need for head lice treatment at home that evening. Following appropriate treatment at home, the student should return to school the next day. Students with nits should not be excluded from school after beginning proper treatment since inactive nits often remain stubbornly attached to the hair (Centers for Disease Control and Prevention [CDC], 2024; Marcoule et al., 2021).
Implementation of exclusionary practices disrupts the educational process which can adversely affect student academic achievement due to missed days from school. In addition, unnecessary student absences can cause negative financial consequences for families due to parental missed time from work and resulting loss of wages (Marcoule et al., 2021).
While it is appropriate for school nurses to assess individual students who are symptomatic for head lice, routine, whole classroom head lice screenings disrupt learning time and have not been proven to identify significant numbers of cases to aid in managing the spread of head lice in schools (Boltas & Smith, 2022; Pérez-Gaxiola et al., 2022). Taking time to screen groups of asymptomatic students also diverts school nurses from attending to other students’ needs.
Sharing information, including broad notifications, about a case of head lice (except for the families of students with head lice) does not effectively diminish the spread of lice. These actions may violate privacy laws and can heighten stigma surrounding having lice and impact students and families emotionally and socially (Hurst et al., 2020; Nolt et al., 2022). School nurses have a duty to uphold student health information confidentiality.
The most effective way to decrease and control the prevalence and transmission of head lice in school, reduce unnecessary absences, and minimize stigma surrounding the condition is through family and school staff education. School nurses have the expertise to provide reliable instruction in the prevention, identification, routine screening at home, treatment, and removal of head lice and nits (Najjar et al., 2022).
Effective head lice management in schools should be based on the most current scientific evidence. As RNs, school nursing leadership in the development and implementation of nonexclusionary head lice policies and practices provides support for the educational process, serves student physical and emotional health needs equitably, and protects confidentiality of care for all students and families (Boltas & Smith, 2022).
National Association of School Nurses1
1 NASN, MD, USA
Adopted: 1999
Revised: 2004; 2011; 2016; 2020; 2025
All position statements from the National Association of School Nurses will automatically expire five years after publication unless renewed, revised, or retired at or before that time. To access additional NASN professional practice documents including position statements, position briefs, and joint and endorsed statements, please go to https://www.nasn.org/nasn-resources/professional-practice-documents
Wendy A. Doremus, DNP, RN—NASN Clinical Writer
Wendy A. Doremus https://orcid.org/0000-0001-7584-0192
Boltas, M. W., & Smith, S. (2022). Staying ahead of head lice: Pediculosis treatment updates. NASN School Nurse, 37(6), 339–344. https://doi.org/10.1177/1942602X221099282
Centers for Disease Control and Prevention. (2024). Providing care for individuals with head lice. https://www.cdc.gov/lice/caring-head/index.html
Guenther, L. L. (2023, Feb. 15). Pediculosis and pharisaism (lice infestation). Medscape. https://emedicine.medscape.com/article/225013-overview
Hurst, S. K., Dotson, J. A. W., Butterfield, P., Corbett, C. F., & Oneal, G. (2020). Stigma resulting from head lice infestation: A concept analysis and implications for public health. Nursing Forum, 55(2), 252–258. https://doi.org/10.1111/nuf.12423
Marcoule, K. Y., Pollack, R. J., Reed, D. L., Barker, S. C., Gordon, S., Toloza, A. C., Piccolo, M. I., Taylan-Ozkan, A., Closedown, O., Habedank, B., Ibarra, J., Meinking, T. L., & Vander Stichele, R. H. (2021). International recommendations for an effective control of head louse infestations. International Journal of Dermatology, 60(3), 272–280. https://doi.org/10.1111/ijd.15096
Najjar, M., Gorgui, M. A., Zarr Infar, H., Farkash, B. R. H., Jamali, J., Moghaddam, E., & Berhampur, M. (2022). Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a subtropical region: A quasi-experimental study. BMC Pediatrics, 22, 424. https://doi.org/10.1186/s12887-022-03492-y
Nolt, D., Moore, S., Yan, A. C., & Melnick, L., & Committee on Infectious Diseases, Committee on Practice and Ambulatory Medicine, & Section on Dermatology. (2022). Head lice. Pediatrics, 150 (4), e2022059282. https://doi.org/10.1542/peds.2022-059282
Pérez-Gaxiola, G., Velásquez-Salazar, P., Veroniki, A. A., Zambrano-Rico, S., Hernández Alcaraz, M., Cuello-García, C. A., & Florez, I. D. (2022). Interventions for treating head lice: A network meta-analysis. Cochrane Database Systematic Revies, 2022(9), CD014735. https://doi.org/10.1002/14651858.CD014735
