"Miss Caroline said desperately, 'I was just walking by when it crawled out of his hair... just crawled out of his hair-'"
"Little Chuck grinned broadly. 'There ain't no need to fear a cootie, ma'am. Ain't you ever seen one?'"
—From "To Kill a Mockingbird," by Harper Lee
Call them cooties, or head lice, or Pediculus humanus capitis, but these tenacious, parasitic insects have managed to eke out an existence limited only to the human scalp for generations; as students return to school after the summer break and the long Labor Day weekend, it's almost a certainty that some will bring lice with them. Others likely will return from school with lice.
"Every school year we certainly have an issue with lice," said Penny Bramlett, program supervisor for maternal child and school health and the Carroll County Health Department. It is the Health Department that writes the lice policy for the school system.
"It does vary. Sometimes one school may have a problem, the next year they may not," Bramlett said.
According to data from Carroll County Public Schools, the 2013 -2014 school year saw 615 cases of head lice. Of those, 15 were in high schools, 88 in middle schools and 511 were found in elementary schools, the primary population affected, according to Bramlett. There was one additional case at Carroll Springs School.
"Little kids share more than we realize, I think," Bramlett said. "Many times their coats are hanging close in their cubby thing and they share combs and they put their heads together."
And so lice have been transmitted among school children year after year, but over the past few years, the way Carroll schools have responded to lice has changed.
According to Bramlett, until a few years ago, Carroll County Public Schools had a no nit policy, meaning a child found to have a nits, the egg stage of the head louse, would be sent home from school, unable to return until there were no nits found in the child's hair. Special medicated shampoos would be applied, fine toothed combs used to remove nits and bedding and clothing washed to remove any chance of re-infestation. Under a new policy, children are allowed back into school after an initial treatment, even if nits are still in the hair.
"We had to change it because there is no support for it anywhere — the Centers for Disease Control does not support no nit, the American Academy of Pediatrics does not support no nit and neither does downtown, the Maryland Department of Health and Mental Hygiene," Bramlett said. "We were just kind of sitting there by ourselves and other counties were changing their policies, so we took away our no nit policy."
There are a number of reasons support has dropped for no nit policies, but according to Bramlett, the biggest reason is that lice simply are not a serious threat to health.
"Head lice at this point in time do not carry any disease," she said. "They are a nuisance, but they are not a danger in any way. Now, parents certainly don't like them, we don't like them, but they do not carry disease."
The present policy is when a child is found to have live adult lice, the insects that feed on blood from the scalp, or nits in their hair, they will be sent home until the parents return with proof of having administered treatment with one of the medicated shampoos available over the counter, according to Filipa Gomes, supervisor of Health Services for Carroll County Public Schools. Parents simply need to bring in the empty bottle; some brand names of qualifying shampoos include Rid and Nix.
"We like the over the counter medicated treatments, but I understand that some families don't believe in that," Gomes said.
"From my previous experience, we've had cases where people decided to use mayonnaise and all sorts of products and it doesn't seem to work and that's where the nurse checks and there is still a live louse, we will say to take your child home and try something else," she said.
Unless a medicated treatment is applied inappropriately, it's very rare to see live lice after a treatment, according to Gomes. Nits may be present, but these are often empty shells from already-hatched lice, which have already been killed by the medication.
People, professionals included, are also terrible at identifying nits, according to Gomes.
"The problem with the nits is that they did a study at Harvard where health care providers sent in what they thought were nits, but it was really inaccurate," she said. "Many people think dandruff is nits."
The end result of a no nit policy was that many children were missing a lot of school for what might have been only the remnants of a lice infestation. Gomes said rather than aiming for zero tolerance toward lice, the schools aim for a case management approach.
"If there seems to be a problem in particular classroom we will look at that class room. If there are teddy bears or something that could be harboring lice, we will have them removed," she said. "We really have to work with the families; there is no way you can do it by yourself."
Even if public health and school officials have decided to end the no nit policy with regard to lice, the parasites can still elicit strong emotions in parents, according to Cheryl De Pinto, medical director for the Office of School Health at the Department of Health and Mental Hygiene. When discussing the shift away from no nit policies, she said it is helpful to dispel some of the myths about lice.
"Some people believe that nits are a sign of poor hygiene, and that is not correct. The nits can adhere very strongly to the hair and therefore, even with good hygiene, they are not able to be loosened with traditional shampoos and things," De Pinto said. "Another myth is that they can hop or jump from one person to another. They have no wings, so they do not fly and do not crawl. Transmission is usually a result of direct head to head contact."
With hygiene not a factor and close personal contact being a universal among young children, De Pinto said there's another corollary myth to be busted: "People think that lice are a disease of poor people or lower socio-economic situations, but it affects every socio-economic group and does not discriminate based on income."
Lice are just something that people will have to deal with from time to time, according to De Pinto, and they are not a reflection of having done something wrong. If a child contracts lice, it's helpful to keep in mind that treatment will eventually rid them of the bugs and keeping a child home for the duration could be counterproductive.
"Nits have a life cycle that they go through and even the best treatments sometimes require a second application," De Pinto said. "They could miss a lot of school for something that is not a medical problem."