When potentially contagious health problems appear at school, the health of your child must be considered along with the health of other children and school staff. Some health disorders are of particular concern in schools. Problems like head lice can spread from one child to another rather easily and thus can become mini-epidemics in classrooms. Other conditions, like AIDS, are much more serious, but concerns about the transmission of the AIDS virus in school have created more anxiety than is warranted. Some childhood disorders (including colds, sore throats, chicken pox, and impetigo) are dealt with in more detail elsewhere on this site.
Head lice are crawling insects, only about one-sixteenth of an inch long that live and multiply in human hair. Lice are not a major health problem, since they do not transmit diseases or cause permanent problems. Nonetheless, the reaction of parents, and sometimes of school staff, has made them a significant health issue.
Lice make their home in human hair, nourishing themselves with blood from the scalp. They can cause reddened, rash like areas. The average number of lice on an infected child's head is about ten. Their eggs (called nits) stubbornly attach to the hair shafts—most often in the back of the head or near the ears—and cannot be shaken or brushed off.
When should you suspect lice? Your child may complain of a very itchy scalp, although lice may be present for weeks or months without causing an itch. If you look carefully at her head, you should be able to see the eggs, although some parents may confuse them with dandruff. (Dandruff, however, tends to be loose flakes of skin, while nits firmly attach themselves to the hair.)
Lice are quite contagious and can be spread quickly by close contact with a friend or classmate, almost always by head-to-head contact. Routine head inspections by school personnel usually miss all but the worst cases.
Lice can be difficult to treat. Your doctor may prescribe a treatment or recommend a nonprescription anti-lice shampoo or rinse containing a substance called pyrethrins. Follow the instructions carefully. Your child will probably need to vigorously scrub in the shampoo, working up a good lather, and then rinse thoroughly. This treatment can often take care of both the lice and their eggs, although a second application may be required several days later. Do not treat longer than the manufacturer or your physician recommends. Unfortunately, many lice have developed resistance to most pesticide medication in common use.
Although lice move quickly away from any disturbance in dry hair, thoroughly wetted, their mobility is much reduced. Fine-tooth combing after ordinary shampooing is a simple way to lift out lice. Repeating this process every three to four days for two weeks is usually effective in ridding a child of head lice. Combing your child's hair with a fine-tooth comb can also remove some nits, as can pulling them off with your fingernails. Be sure to wash the comb thoroughly or soak it in anti-lice shampoo before anyone else uses it.
The presence of lice does not mean that your child has poor hygiene habits. Anyone can get lice, even if she bathes or shampoos every day. As a preventive measure, discourage your child from sharing combs, brushes, towels, or hats with friends.
Many schools have policies about children with lice. In most of these schools, students with live lice are sent home when the lice are discovered; those students who have only nits and no live lice are usually sent home at the end of the day with a note, although it is likely that if nits are present in a child who has not received treatment, live lice are also there. Students can be readmitted to school once they have been treated. Some schools have "no-nit" policies, stating that students who still have nits in their hair cannot return to school; however, since many anti-lice shampoos effectively kill the nits, many schools do not feel this extra restriction is needed.
Cooperate with the elementary or middle school by notifying the staff if your child has become infected. Although school personnel and parents used to overreact to the presence of head lice in the classroom, this type of response is hopefully a thing of the past. Most people now recognize that lice can happen to anyone and do not pose an emergency situation.
Fifth disease (Parvovirus B19) is a viral disease that causes a lacy-appearing rash on the arms and creates a "slapped cheeks" look on the face. Since children rarely feel sick with this disease and are contagious only before they develop the rash, there is no reason to exclude them from school unless they feel too ill to attend class. This disease can be dangerous for a developing fetus, so whenever a case is detected, all female school employees should be notified. It can also be more serious for people with some hereditary disorders, such as sickle-cell disease, that affect red blood cells.
AIDS/HIV infection is an increasingly common, life-threatening infection that affects children as well as adults. Unfortunately, there is widespread but unwarranted anxiety among parents whose children attend school with a youngster with AIDS, fearing that their own child may contract the disease. The AIDS virus (human immunodeficiency virus, or HIV) is transmitted only through blood, blood products, and sexual contact. Casual physical contact—including touching or holding hands with someone with AIDS, or sharing a drinking glass—will not transfer the AIDS virus.
Your child will not be in danger if she attends school with someone with AIDS, even if she plays with the same toys or is exposed to coughing or sneezing. There is not a single documented case of the transmission of AIDS from child to child, or teacher to child, in the school setting. To allay parental concerns and to significantly lower the risks, schools have implemented procedures for dealing with the blood and other bodily fluids of all staff and students. Children with AIDS whose pediatricians have approved their attendance pose no danger to their peers and should attend school.
Hepatitis is an infection of the liver, spread by a virus. Its symptoms include jaundice (yellowish discoloration of the skin), loss of appetite, nausea, weakness, and abdominal pain. There are several major types of hepatitis—types A, B, and C—and while all are cause for concern, hepatitis A tends to occur most often among children. These viruses are present in the blood and in bowel movements; thus, children should wash their hands after every bowel movement and before eating. As with AIDS, precautions should also be taken around the blood of infected individuals.
Children infected with acute hepatitis A should remain at home until one week after the onset of their illness and until jaundice (yellow skin color) has disappeared. Youngsters who are hepatitis B or C carriers but are symptom-free can attend school.
Chicken pox is a common viral disease among children. Although youngsters are contagious before they break out with skin lesions, they should not return to school until the sixth day after the rash has appeared, or sooner if all the lesions have dried and crusted. Vaccines to prevent chicken pox are available and safe. All school-age children who have not had chicken pox should be immunized. Widespread use of this vaccine will make chicken pox much less common in school-aged children.