Hair loss, or alopecia, isn't just a problem for adults. Hair loss in children is responsible for an estimated 3% of pediatric office visits in the U.S. Whether your child has thinning hair or distinct bald spots, the loss of hair can be frightening. The good news is that, with a proper diagnosis, most cases of hair loss can be treated successfully.
Medical Causes of Hair Loss in Children
For the majority of children 26 months or older suffering hair loss, one of the following conditions is the cause. Your child's pediatrician or a pediatric dermatologist should be able to diagnose these conditions and prescribe the appropriate treatment.
Tinea capitis. Tinea capitis, commonly known as ringworm of the scalp, is a fungal infection often seen in children. It can show up in a number of ways, but often as scaly patches of hair loss on the head. The patches are usually round or oval. The hairs may be broken off at the surface of the skin and look like black dots on the scalp.
If your child's doctor suspects tinea capitis, a microscopic examination can confirm the diagnosis. Treatment usually involves an oral antifungal, such as griseofulvin taken by mouth for eight weeks. Your child should also use an antifungal shampoo such as selenium sulfide or ketoconazole to decrease shedding of the fungus.
Because ringworm is contagious, your child should be careful not to share any objects that touch the head such as hats, pillow cases, hair clippers, or brushes.
Alopecia areata. Alopecia areata is a non-contagious condition of hair loss thought to be caused by the body's immune system attacking the hair follicles. It is characterized by the sudden appearance of round or oval patches of hair loss. The patches are slick or smooth, without scaling or broken hairs. About 25% of children also have pitting and ridging of the nails.
While there is no cure for alopecia areata, treatment can control the disease in some children. Many have their hair back within a year, although regrowth is unpredictable and many will lose hair again. For about 5% of children the disease progresses to alopecia totalis -- loss of all of the hair on the scalp. Some of these will develop alopecia universalis -- a total loss of body hair.
For younger children, treatment consists primarily of strong corticosteroid ointments or creams applied to the bald areas. Teenagers, who may be sufficiently motivated to have their hair return, may tolerate steroid injections into the scalp. Minoxidil (Rogaine) is often used in additional to topical steroid treatment. Anthralin applied to the skin for a short time and then washed off may also be used. Hair growth may come back in 8-12 weeks.
Trichotillomania. Trichotillomania is hair loss caused by the child pulling, plucking, twisting, or rubbing their hair. The hair loss is patchy and characterized by broken hairs of varying length. Patches are typically seen on the side of the child's dominant hand.
Trichotillomania may be triggered by a stressor or anxiety in your child's life at home such as the loss of a grandparent, birth of a sibling, or a divorce or a school stressor. If you notice your child pulling hair, scolding will not likely be helpful. However, counseling to help your child deal with the source of stress or anxiety that triggered the habit may help stop it .
There is another condition called traction alopecia that occurs when braids or pony tail holders are put in too tightly resulting in loss of hair at the hair line. It may present with inflamed follicles at the area of irritation. It can be treated with a topical antibiotic ointment and loosening of braids or ponytail
Telogen effluvium. Telogen effluvium is a condition in which a sudden or severe stress -- such as extremely high fever, surgery under general anesthesia, the death of a loved one, a severe injury, or the use of certain prescription medications -- interrupts the normal cycle of hair growth. The hair follicles stop growing prematurely and enter a resting phase (called the telogen phase). Between six and 16 weeks later, hair sheds excessively, leading to partial or complete baldness.
There are no conclusive tests to diagnose telogen effluvium; there is also no treatment for it. However, once the stressful event is over, full hair growth usually returns within six months to a year.
Nutritional deficiency. Though less common, hair loss can be a symptom of deficiencies in certain nutrients, including:
- Vitamin H, or biotin, one of the B complex of vitamins, which help the body to convert carbohydrates into glucose to fuel the body.
- Zinc, an essential mineral involved in numerous aspects of cellular metabolism. It also supports normal growth and development during pregnancy, childhood, and adolescence.
In some cases, hair loss can be a symptom of too much vitamin A.
With a healthy, varied diet, most children will not experience nutritional deficiencies that lead to hair loss. However, if you suspect a problem, speak to your child's doctor before giving nutritional supplements.
Endocrine problems. In some children the cause of hair loss is hypothyroidism, a condition in which the thyroid is underactive and is producing an insufficient amount of thyroid hormones required for regulating metabolism.
A diagnosis of hypothyroidism is made by a blood test. Treatment may involve medication prescribed by the endocrinologist to replace deficient hormones but will depend on a number of factors including:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Nonmedical Causes of Hair Loss
While many causes of hair loss require a doctor's attention, others will resolve on their own with time. These include.
- Newborn hair loss. Many newborns lose their hair during the first few months of life, and baby hair is replaced by permanent hair.
- Rubbing. Between 3 and 6 months of age, many babies have a bald spot resulting from friction with the crib mattress or car seat. Once your child starts sitting up, any lost hair should return.
- Hair abuse. Vigorous brushing or pulling the hair into tight pony tails or braids can cause it to fall out. Being more gentle with the hair will allow it to grow back.
There are many reasons for hair loss in children. If you suspect a medical problem or have any concerns about hair loss, it's important to call your child's pediatrician.