Lice | FAQs


Should schools have a "No-Nit" Policy?

American Academy of Pediatrics (AAP) attempts to clarify diagnosis and treatment of head lice and makes recommendations for dealing with this condition in school. Among its recommendations, the AAP says no healthy child should be excluded from, or allowed to miss school because of head lice, and that "no nit" policies for return to school should be discouraged. Numerous anecdotal reports exist of children missing weeks of school and even being forced to repeat a grade because of head lice. Although not painful or a serious health hazard, head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work, and millions of dollars spent on remedies. The AAP recommendations for treating head lice also include:

    • School personnel responsible for detecting head lice should be appropriately trained, as it can be difficult to diagnose.
    • Permethrin 1 percent (an insecticide) is currently the recommended treatment for head lice.
    • Head lice screening programs in schools do not have a significant effect on the incidence of head lice, and are not cost-effective. Parent education programs may be a more appropriate management tool.
    • Manually removing nits after medication for killing lice is not necessary to prevent spread. However it may be prudent to remove nits in school-aged children to decrease the chance of misdiagnosis. Nit removal is tedious and often cannot be accomplished in one sitting.

What should school personnel do if they find a bedbug on a child's clothing or in their belongings?

Richard Pollack, PhD, formerly Research Associate, Department of Immunology and Infectious Diseases for the Harvard School of Public Health, currently with Identify Us, an independent company, has addressed this issue. Please see his answer in the "A-Z Index" under "B" for Bed Bugs



I have heard that head lice medications do not work, or that head lice are resistant to medication. Is this true?

A recent study done by Harvard University did show that SOME, but NOT ALL (or even most) head lice are resistant to common prescription and over-the-counter medications (OTC). There is no information on how widespread resistance may be in the United States. Resistance (medication not working) is more likely in people who have been treated many times for head lice. There are many reasons why medications may seem not to work. Below are some of those reasons: 

  1. Misdiagnosis of a head lice infestation. A person has head lice if they have crawling bugs on their head or many lice eggs (also called nits) within a quarter inch (approximately the width of your pinky finger) of the scalp. Nits found on the hair shaft further than 1/4 inch from the scalp have already hatched out. Treatment is not recommended for people who only have nits further than one-quarter inch away from the scalp.
  2. Not following treatment instructions fully. See instructions below for how to treat a head lice infestation. Using medication alone is not likely to cure a head lice infestation. 
  3. Medication not working at all (resistance). If head lice medication does not kill any crawling bugs, then resistance is likely. If the medication kills some of the bugs, then resistance to medication is probably not the reason for treatment failure (see item #2 and #4).
  4. Medication kills crawling bugs, but is not able to penetrate the nits. It is very difficult for head lice medication to penetrate the nit shell. Medication may effectively kill crawling bugs, but may not treat the nits. This is why follow-up treatment is recommended. See instructions below for a detailed summary.
  5. New infection. You can get infested more than once with head lice. Teach family members how to prevent re-infection.

Does Medicaid (like Fidelis) cover lice medications – Sklice and Natroba?

All are prescription drugs, so insurance coverage will vary depending on the insurance plan. Natroba, Sklice and Ulesfia are all on NYS Medicaid’s reimbursable drugs list. A comparison chart can be found on this website under “L” for lice.

Page updated 12/19/16