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Head Lice


Guest sn0wdr0p
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Guest sn0wdr0p

We have a four year old child who started with us after easter who has head lice - a LOT of head lice. She also has an serious eczema problem and her head is covered in many many large scabs and some areas have pus leaking. ( That is a separate safeguarding issue which I am currently addressing. Parents have done nothing about it and do not regularly apply cream to her body or use the shampoo prescribed by the GP because "it does not work". Following a 'discussion' with the parents last week they have finally taken her back and got some different shampoo. I am monitoring this closely).

However as always I digress. A staff member noticed the head lice today when this child returned from the half term break and spoke to Dad when he collected her. (Sadly I was out at a meeting) He said they could not treat them as they could not put a comb through her hair because of the scabs nor use head lice shampoo bacause of the open sores on her head. Now I understand totally where he is coming from but neither do I want an outbreak of headlice in the setting. Judging by the number in her hair it is inevitable that she will pass them on. She could have them for some significant time and I do not want children in the setting to repeatedly get them. What would you do? Where do I stand? Can I stop the child from coming in to the setting - it may well be for a few weeks?

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This is really difficult. A TA at our local school ended up going round to a child's home to comb and condition as a friend to solve this problem once.

They don't need to use a special shampoo. They just need to get live lice out by combing with a nit comb and conditioner in order to prevent transmission. Is her hair getting washed at all? If so could you encourage them to try? The sores will only get worse if they don't treat the lice.

I don't think you can stop the child attending and I wouldn't want to if there are safeguarding concerns. You may be the only people having regular contact and monitoring the child's well being.

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Well,my thoughts are...our policy states that they need to be treated before returning and then a second one a week later. Now, in reality,we are trusting what parents tell us,I know, but in this case, I would feel that if the child is not going to be treated (parents have told you this) and therefore 'visitors' are not going to be eliminated, I would say,come back when cleared.

I will be interested to see what others think though. It is a difficult one...

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I think this is one when I would be contacting the HV to give support in the home.

This poor child must be feeling really agitated with the ezcema along with the head lice.

Our policy is inline with the HPU guidance which stipulates no exclusion, once treatment has started.

However in this case I think I might be offering to help with the combing and conditioner route too.

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Well we were told by someone in authority (can't remember who though) that we couldn't even tell parents if we knew their child had headlice! Just have to do a generic letter to all. I didn't think you could require them to treat and definitely couldn't exclude? I would be asking if we could treat at nursery maybe???

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I've heard of a setting recently that had an inspection triggered by a complaint by a parent whose child was excluded because they had headlice. Ofsted made it very clear that this is not acceptable.

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I feel really sorry for this poor child - doesn't this constitute neglect?

I think once again, we are in muddy waters and the rights of the other children matter just as much as the child with a severe on-going infestation. I was told by our LA that we should include, but if we put it in our policy what we require as treatment, then we are fine as it is our policy. I have it in ours that we will ring parents if we find lice and they have to give treatment over 48 hours. What one setting has been told however will conflict with another, just like an Ofsted inspector would give you conflicting advice. This is the never ending frustrating part of our job, there is no universal advice apart from statutory requirements and everything is constantly under review or left to interpretation.

I would also like Ofsted to spend a year In a setting on our wages and go through an inspection themselves before they are qualified to inspect and quite frankly (dare I say this?) I am fed up with liberalism too. We are not all the same!

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From what you describe it seems to me that this is a health issue and neglect, as MegaMum says.

You mention that you are addressing safeguarding concerns so I presume there is a social worker involved & child is on a CP plan anyway. If this is the case I suggest you phone the social worker and explain what has happened and that you are very concerned about the effect this could have on the child's general health. It is not your job to deal with the lice - in fact I think you could be in trouble if you did. The social worker needs to speak to the Health Visitor and she will then have to organise how the problem is dealt with.

This needs to be addressed for the child's sake. I once saw a case where head lice had not been addressed for months. The child's whole head was covered in pus and infected. It was just terrible.

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could you suggest to the parents that they ask the doctors advice on a good treatment for the headlice, if the child has open sores on their head this may affect they sort of treatment they can use ?

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In school, I used to have a chart saying when children were to stay at home and for how long. Surely headlice are contagious and it is a health issue - would children be allowed in with scabies, ringworm, impetigo....... This child does have other issues though so being in school might be the best place??

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I have the chart and we're not allowed to exclude for headline. There are quite a few things were not allowed to exclude which you would think you could I.e conjunctivitis .

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So sorry for this child. The eczema might well be a barrier to lice treatment, as many things ( including conditioner) can make her head even worse and sting like the furies. No, you can't prevent her from coming to the setting and by the sounds of things, she needs to be there as a very stable part of her life.............so long as staff ( and I am NOT suggesting any would, but nits/lice are such an emotive subject), don't behave any differently to her than any other child. So, if she needs a cuddle, she gets one etc.......and of course, if other children or parents pass comment, they need to be pulled up on it. For this child, it's an awful thing and I am sure the doctor could sort out something for her. Failing that, can't you ring the H/V yourself to ask what might work in this particular case? You don't have to name names, though of course, if you want the HV to visit, then you have to. I've lost count of the number of times I personally have had nits over the years, it's horrid, but easily treated for most of us ( though I'm shocked at how much the stuff costs nowadays!)

For her eczema, ask if they have tried Dermol.................my son in law suffers dreafully and this really works for him and its available on prescription. Good luck to you and this little girl, she sounds like she needs someone watching out for her x

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Guest sn0wdr0p

Oh dear there is definitive answer is there? I am going to go back to the parents and ask them to go back to the doctor. If they fail to do this I am going to ask the HV to go in and give advice and see what happens then. I didn't think I could exclude her nor would I consider asking my staff to treat her. This is really a medical issue and I would not be comfortable dealing with it. In reality I am sure other parents would really object if they knew (of course they never will).

I really hope I don't get them as I have long and very very thick hair and have to use a few bottles when treating myself and it ends up rather expensive. Fortunately it is free on prescription for children. Putting my hair up in a tight bun today.

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Guest sn0wdr0p

Thank you for all your replies. I have phoned my sister who is a nurse practitioner at the local surgery and asked for advice - naming no names of course. She is going to speak to one of the GPs after surgery today so hopefully I will get some more help and information about what to do.

 

I spoke in more detail to my staff member who spoke to Dad last night and she told him we may contact the health visitor and he was more than happy about it so I will follow that up as well.

 

I do not have a written head lice policy and wondered if anyone would be willing to share theirs please.

 

Sadly Narnia I am the owner so it is my own money anyway.

Edited by sn0wdr0p
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If your setting requires a child to be treated, would you accept combing as the treatment?

After having a long chat with our school nurse about head lice which was prompted by my daughter catching them often for a while, I looked into the various treatments available and I came to the conclusion that there is little to be gained by buying treatments. Every one requires that you comb through the hair thoroughly with a nit comb and repeat a few days later. What you put on the hair doesn't seem to make much difference.

Lots of parents I know feel the same and find that conditioner with thorough combing is just as effective. In fact it was more effective for us. As long as the combing is thorough and repeated at least twice a week for more than three weeks, it works. You can layer your own hair and do it yourself and you can sit children in front of a DVD if they find it too boring.

If I had a child in an early years setting who required that they were treated, they would have to accept combing and conditioning as the treatment.

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Oh dear there is definitive answer is there? I am going to go back to the parents and ask them to go back to the doctor. If they fail to do this I am going to ask the HV to go in and give advice and see what happens then. I didn't think I could exclude her nor would I consider asking my staff to treat her. This is really a medical issue and I would not be comfortable dealing with it. In reality I am sure other parents would really object if they knew (of course they never will).

I really hope I don't get them as I have long and very very thick hair and have to use a few bottles when treating myself and it ends up rather expensive. Fortunately it is free on prescription for children. Putting my hair up in a tight bun today.

Or wear a baseball cap!

 

Can't offer any other advice than anyone else I'm afraid, poor little one must be absolute misery for her. When hair gel was really popular one of our families used that and found it a good preventative after the combing and conditioning.

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It's no longer available on prescription in our area for children, and hasn't been for some time, which is a huge issue with parents when certain children repeatedly have headlice or are not treated and they then have to keep treating their children at a considerable expense.

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Guest sn0wdr0p

OK it is now a week later and real progress has been made. I spoke to the safeguarding team and they were happy for me to deal with it - with the proviso that I must get back to them on the Monday if parents were not willing to take action. I spoke Mum and explained that she MUST do something. The next day she told me that they had combed through daughters hair and the siblings hair and had removed everything. Following using the new eczema shampoo the girl said on Wednesday that her head didn't hurt anymore (bless her).

I was sat reading a story to the children yesterday and spotted a moving insect in her hair! She was scratting rather a lot as well. I took a look later and found a number of eggs and 3 lice. Spoke to mum again who said now her scalp had healed she would use some head lice shampoo on it. Hooray. We have made real progress and mum is onboard.

This little girl was playing dress up yesterday -wigs- tiaras etc. so I asked the staff to surreptitiously (how do you spell that?) remove each item after she played with it before another child got it!

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I have the chart and we're not allowed to exclude for headline. There are quite a few things were not allowed to exclude which you would think you could I.e conjunctivitis .

I dont think its a case of not being allowed to exclude- more it does not recommend any exclusion period. It does however assume the child is being treated i.e combing through regularly. Glad you now have it sorted.

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I dont think its a case of not being allowed to exclude- more it does not recommend any exclusion period. It does however assume the child is being treated i.e combing through regularly. Glad you now have it sorted.

In the case I mentioned above where a complaint about a child being excluded resulted in the inspection, Ofsted said in no uncertain terms that it was 'illegal' to exclude the child. So now they've had to change their policy in this regard.

Glad it is all getting sorted now - must be a huge relief to you all.

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Glad to hear the parents are being supportive, well done you and your team :1b

- was going to suggest that if you find them saying they are going to the GP (about anything) and you are suspicious to if they have, then a phone call to the HV and she can check. This will be logged as a positive on their behalf on the safeguarding record if they did attend and a negative if they didn't

 

How is it 'illegal' to exclude for headlice? (not doubting your word Maz - just can't believe it?) Surely it's in the best interests of every child to have it sorted out asap - especially if some children have skin like the child above and would be in pain to have the treatments on/combed - isn't it positive safeguarding children's health??

- in this day and age headlice should be a thing of the past - it's not, because some families don't address it and it becomes 'acceptable'

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How is it 'illegal' to exclude for headlice? (not doubting your word Maz - just can't believe it?) Surely it's in the best interests of every child to have it sorted out asap - especially if some children have skin like the child above and would be in pain to have the treatments on/combed - isn't it positive safeguarding children's health??

 

Supporting families and keeping their children in the setting where their well-being can be monitored is a much better method of safeguarding children who are risk of neglect.

Excluding them removes the problem from the setting but it doesn't help the child if the parents don't have the skills to manage the situation without support.

 

I think Sn0wdr0p has done a brilliant job here, keeping the child in the setting and supporting the family positively and sensitively. A great outcome.

 

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Guest sn0wdr0p

Thank you for your comments. I will continue to keep a close eye on the situation.

 

P.S. Used my head lice comb yesterday and found NO eggs or lice. Phew. I also used some ingenious concoction today to remove all hair colouring from my hair in prep for going grey gracefully and considering the horrendous smell it gave off which almost killed me it sure would have killed any I may have missed yesterday.

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How is it 'illegal' to exclude for headlice? (not doubting your word Maz - just can't believe it?)

I've just had another look at the inspection report but this issue isn't specifically mentioned, so I can't quote you what they said. I only know from one of the practitioners who works there that this is what they've been told. If I find anything else I'll be sure to pass it on.

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