Hair loss in children: What to know

Many adults expect to lose some hair as they age, but hair loss in children can cause alarm, especially when they become upset about bald spots or thin hair. However, hair loss in children is relatively common.

Hair loss in children may have different patterns to adult hair loss. For example, androgenetic alopecia, or pattern baldness, is the most common cause in adults. In children, common causes include fungal or bacterial infections, telogen effluvium (stress-related hair loss), and traction alopecia.

However, the most common cause of hair loss in children is scalp ringworm, which is a treatable fungal infection. Doctors can treat most causes of hair loss and can often reverse it.

This article looks at the possible causes of hair loss in children, other symptoms, and treatments. It also discusses when to see a doctor.

The following sections look at possible reasons for hair loss in children and ways to treat them.

Scalp ringworm

a parent or caregiver inspecting her child for hair loss. Share on Pinterest
A fungal or bacterial infection may cause hair loss in children.

Ringworm is a common, contagious fungal infection of the skin. It causes a red, ring-shaped rash. When ringworm affects the scalp, it is known as tinea capitis.

Red, patchy, or itchy spots may appear on the scalp. Caregivers may notice that their child scratches or rubs their scalp.

Scratching the infection and damage to the scalp from the infection itself can slowly cause hair to fall out. Some children may also pull their hair to try to relieve the itching. The hair loss usually happens in just one or two locations — typically over areas of itchy and irritated skin.

A doctor may prescribe antifungal cream for the scalp. When the ringworm clears up, the hair should begin to regrow.

Alopecia areata

Alopecia areata is a type of hair loss that causes the body’s immune system to attack hair follicles. It can occasionally cause total baldness or very thin hair. Some children also lose their eyebrows and eyelashes. The bald spots that remain are usually smooth and skin colored.

Many children with alopecia areata experience flares, or periods during which the hair falls out, followed by periods of regrowth. Doctors have identified several subtypes of this disorder, and the pattern of hair loss varies from person to person.

There is no cure for alopecia areata, but some treatments may help manage symptoms. There are no specific drugs available to treat alopecia areata, but doctors can prescribe off-label drugs that might help stop the body from attacking hair follicles.

Sometimes, light therapy may stimulate hair growth. In many cases, the hair begins to fall out again after a child stops treatment, so a child may need to continue treatment even after symptoms disappear.

Hair pulling or twirling

Children who twirl their hair may damage the hair follicles, causing the hair to fall out. Some children pull their hair because of anxiety. Doctors call this trichotillomania.

When the person stops pulling or twirling their hair, it should regrow. Hair pulling is a type of anxiety or obsessive-compulsive disorder, so it is essential to treat the underlying cause. A child may benefit from therapy, emotional and social support, or medication.

Traction alopecia

Traction alopecia is a type of hair loss that happens when the scalp experiences long term tension or pulling, such as wearing very tight braids or ponytails for long periods. Some people also develop traction alopecia from poorly placed extensions. This can happen due to getting cheap extensions or attaching extensions at home.

The scalp may be itchy and red, with large bald or thinning spots. The hair loss usually concentrates on areas where there is the most pressure. For example, a hairstyle that places tension on the hair at the temples will cause more hair loss there.

Traction alopecia should go away on its own with a looser hairstyle, but it can take time for the hair to regrow. If a person with this type of hair loss develops a scalp infection, a doctor may recommend antibiotics.

Scalp injury

An injury to the scalp, such as a burn or significant blow to the head, may damage the hair follicles. This can cause significant hair loss at the site of the injury. When the injury heals, the hair should regrow.

Prompt treatment is essential because untreated scalp injuries can damage underlying structures and may even cause permanent hair loss.

Telogen effluvium

Telogen effluvium is a form of temporary hair loss that occurs after a physical or emotional shock.

Healthy hair grows on a predictable schedule. A hair may grow for 2–6 years. This is the anagen phase. The hair then goes into a “rest period,” called the telogen phase. This phase lasts 2–4 months before the hair falls out and new hair replaces it. When hair is healthy, 80–90% of hairs are actively growing at any given time. Telogen effluvium happens when something causes more hairs than usual to enter and stay in the telogen phase.

Some potential causes of telogen effluvium include:

  • physical injuries
  • emotional stress
  • fever or infection
  • surgery with general anesthesia
  • some medications, such as the acne medicine Accutane
  • vitamin and nutritional imbalances, such as too much vitamin A

Often telogen effluvium remains untreated because people do not know they have it. Because it takes several months for hairs to fall out during the telogen phase, a person may not notice any increased hair loss for some time. By this time, it is often too late for treatment. In most cases, the hair grows back over time.

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