Causes of Hair Loss in Children

Father brushing daughters hair in bathroom
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Hair loss (alopecia) is a scary and frustrating symptom for parents, especially since you don't really expect kids to lose their hair. Unfortunately, hair loss is a common symptom, even in kids. In many cases the hair loss is temporary and the child's hair does grow back.

Hair Loss

One of the classic causes of hair loss in children that many people think about is hair loss associated with childhood cancer. Although this can definitely cause hair loss, it is usually the cancer treatments, such as chemotherapy or radiation (anagen effluvium), that causes the hair loss and not cancer itself.

Telogen effluvium is another classic cause of hair loss in children, but this condition is often poorly understood by parents. Children with telogen effluvium have often had a recent illness, typically with a high fever, surgery, sudden weight loss, or even emotional stress, and then suddenly lose a lot of hair about six weeks to three months later.

Children with telogen effluvium continue to lose hair, often in large clumps for a few weeks or months, to the point that their hair may be noticeably thin. But then their hair begins to grow again in about six months without any treatments. It is thought that this hair loss occurs because the original stressor pushes the child's hair into a resting or dormant phase, instead of its more usual long growth phase. It then falls out until new hair grows and then follows the normal growth phases for hair.

Common Causes

Other common causes of hair loss in children and teens include:

  • Ringworm of the scalp (tinea capitis) is one of the more common causes of hair loss but is often easy to recognize because of the association scalp findings, including a red circular lesion, hair loss, and a scaly border that may be itchy. Scalp ringworm signs and symptoms can be more subtle, with no scaling or itching, and broken hairs instead of hair loss (black dot tinea capitis).
  • Bacterial infections can cause some hair loss that appears similar to tinea capitis with scaling. But instead of being caused by ringworm, it is often caused by the Staph aureaus bacteria.
  • Traction alopecia is common in kids who wear tight braids or ponytails and in newborns and infants who lose hair on the back of their head from rubbing it against their crib.
  • Hair pulling or stroking can be a habit for infants and toddlers, just like thumb sucking, sucking on a pacifier, or rubbing a blanket. It usually stops when kids are around two or three years old, just like thumb sucking, although some continue pulling until they are three to five years old. Although you can ignore this habit, since it does sometimes cause some hair loss, you could keep your child's hair cut short or try to move her to one of those other habits if it bothers you.
  • Trichotillomania is thought to be related to obsessive-compulsive disorder and is defined as a child or teen who compulsively pulls out her hair, feels tension before pulling or when trying to resist pulling, and feels pleasure, gratification, or relief when pulling her hair out. These children have noticeable hair loss and often need treatment from a child psychiatrist and/or child psychologist who specializes in trichotillomania.
  • Alopecia areata is thought to be an autoimmune disorder (the child's immune's system attacks the hair follicles) that causes complete hair loss in round or oval patches on a child's scalp or another body part. Unlike ringworm, the scalp involved in the round patches of alopecia areata is completely smooth, without redness or scale. Treatments include steroid injections and some topical medications (such as minoxidil, anthralin cream, or high dose steroid creams). Fortunately, hair growth often eventually occurs on its own, too.
  • Alopecia totalis and alopecia universalis are similar to alopecia areata, except that the child loses all scalp hair (alopecia totalis) or all scalp hair and all body hair (alopecia universalis). The chances for treatment success and hair regrowth are less for alopecia totalis and alopecia universalis than they are for alopecia areata. A pediatric dermatologist can help treat your child with any of these disorders. In addition to the treatments already mentioned for alopecia areata, other treatments might include ultraviolet light therapy (PUVA), oral steroids, or oral cyclosporine.

A high-quality wig is sometimes the best treatment for alopecia areata and alopecia totalis.

Other Causes

In addition to ringworm, hair pulling, traction alopecia, and the other causes of hair loss mentioned above, other less common causes of hair loss can include:

You would usually expect your child to have other symptoms besides hair loss if he had any of these disorders. For example, vitamin A toxicity also causes headaches, vision changes, irritability, vomiting, and poor weight gain, etc.

Hair loss can also be caused by structural abnormalities of the hair shaft, which usually results in easy breakage and dry, brittle hair. A pediatric dermatologist can usually identify this kind of abnormality by looking at the hairs under a microscope.

Help for Hair Loss in Children

A visit to your pediatrician is likely your best first step if your child is losing her hair.

She will likely be able to diagnose and treat common causes of hair loss, such as ringworm, traction alopecia, and telogen effluvium. For other conditions, including trichotillomania and alopecia areata, your pediatrician will likely refer you to a specialist for further treatment.

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Article Sources

  • Habif: Clinical Dermatology, 4th ed. Mosby; 2009.
  • Kliegman: Nelson Textbook of Pediatrics, 18th ed. Saunders; 2011.