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Scratching our heads on camp policies: Head lice outbreaks cause great burden on campers, staff

Summer camps more likely to have ‘no nit’ policies that may unnecessarily exclude some campers

ANN ARBOR, Mich. —    As a former camp counselor, Ashley DeHudy, M.D., remembers the frenzy caused by one four-letter word.


“It was the bane of our existence,” remembers DeHudy, a pediatrician at University of Michigan C.S. Mott Children’s Hospital. “It was one of the most dreaded things besides norovirus or another gastrointestinal outbreak.”

Her own years of camp experience is part of what led DeHudy to embark on a three-year project to track lice infections in more than 200 summer camps.

DeHudy and colleagues found that 60 percent of participating camp leaders viewed the detection and management of a lice infection a substantial burden on staff and camper families.  Still, more than 40 percent of those surveyed were either unaware or had no formal head lice policy.
The team also found that because of outdated policies and limited resources, campers were often unnecessarily being excluded and sent home –  leading to kids missing out on the camp experience, social stigma and families experiencing unplanned logistical and financial challenges.

DeHudy recently presented the findings at the American Academy of Pediatrics National Conference & Exhibition.

“Lice infections represent a unique challenge for summer camps,” DeHudy says. “Unlike schools, children are often far away from home, which creates logistical issues regarding when, where, and how to manage treatment.

“Most camp staff also do not feel well trained in recognizing or treating lice.”

While the American Academy of Pediatrics has a policy for head lice management in the school setting, there is no such policy tailored for summer camps.

DeHudy and colleagues found that less than 20 percent of campers with lice or nits were able to stay in camp. Of those children who did receive treatment in camp, only 40 percent received a second treatment as recommended. 

Thirty percent of responders noted a “no nit” policy (which excludes campers based on the presence of lice eggs rather than live lice) despite evidence that these policies are helpful in reducing the spread of lice. The AAP has stated that children should not be excluded based on the presence of “nits only.”
Authors note that camp leaders welcomed education around lice management issues and helping staff understand that there is no evidence that no nit policies are helpful to prevent spread.

“Camp staff understandably identify head lice as a major drain on resources, but if we take time to educate staff in proper treatment, they can control outbreaks more effectively in less time,” DeHudy says. 

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