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Quick reference medical handouts used by Pediatric offices


Trichotillomania (Hair Pulling) in Children


 
Parents:
Do not blame yourself for your child's hair pulling.

Accept that your child has Trichotillomania, do not try and avoid it.

Listen to your child and provide unconditional acceptance

Trichotillomania is the medical term for a condition that describes young children and adolescents who pull out the hair from their scalp, eyelashes, eyebrows, or other parts of the body, resulting in noticeable bald patches.

It is estimated to affect one to two percent of the population, or four to eleven million Americans, and often begins in childhood and adolescence.

Although the symptoms range greatly in severity, location on the body, and response to treatment, most children with Trichotillomania pull enough hair over a long enough period of time that they have bald spots on their heads (or missing eyelashes, eyebrows, etc.) pubic, or underarm hair), 

Trichotillomania does not cause permanent hair loss, harm to the hair follicles nor does it cause brain damage. When the pulling, twisting or plucking stops, the child's hair will grow back normally. Trichotillomania is quite common in children and the behavior responds well to treatment.

The main concern for the physician diagnosing hair pulling is to rule out other problems that may be related to the hair loss. Medical conditions such as alopecia areata and tinea capitis should be ruled out. In addition, the physician will want to measure how the child is functioning, preferably from both a parent and a teacher, in order  to determine if any stress is playing a role in the child’s hair pulling.

Babies: 1 month to 2 years

Hair pulling at this age is usually a self-comforting habit. It often goes along with thumb sucking. The baby reclines with thumb or fingers in the mouth and twists his/her own or his mother's hair with the other hand. The child finds this relaxing and usually engages in the behavior before falling asleep or when he/she is distressed.

Toddlers: 2 to 5 years

When a child has been pulling at their hair since infancy, the toddler will be in the habit of doing it without thinking. At around the age of three, children can tell when parents are reacting to what they do. If parents get worried or upset when their child pulls at his hair, he soon will learn how to get parental attention with this behavior. Hair pulling is used by the toddler as an effective addition to kicking and screaming during a tantrum. Younger children usually twist hair and the older ones pluck at their hair.

School age: 5 to 12 years

Trichotillomania can be a simple habit, an angry protest or a sign that a child is anxious or under stress. When a child only starts pulling their hair out at school age, there may have been other causes for the problem. It may be school-related stress or it can be an indication that something is worrying ythe youngster.

During this period, many children find it hard putting into words their troubles or feelings. This is more often the case in children who pull eyelashes or eyebrows. Children of this age become much more secretive about pulling out their hair. It may be hard, as a parent, to believe what is happening if they don't actually see their child pulling out his or her hair. Efforts to catch him/her doing it or frequent questioning will not help.

Adolescence: 12 to 18 years

Trichotillomania in adolescence is frequently similar to another childhood behavior called Obsessive Compulsive Disorder (OCD) which can cause the teen to develop troubling thoughts and rigid rituals. Alternatively, it may also be part of the adolescent struggle to be independent, an expression of rebellion or a symptom of anxiety.

 
Remember:
  • Pulling hair out does not cause permanent hair loss
  • Treatment is available and effective
  • There are different reasons for the same behavior at different ages

Management

When Trichotillomania is a self-comforting habit, the management plan worked out by your child's doctor will give parents ideas on how to help their child. High risk times include when a child is tired, just before falling asleep, watching television and when bored (eg. during car travel).

Ideas that may help include:

  • A short haircut.
  • Hair net or cap to sleep in.
  • Cotton gloves or mittens for high risk times.
  • Give your child objects that feel like hair to fiddle with, eg. pipe cleaners, satin ribbons or feathers. These can be swapped about to keep your child interested.

Thumb sucking often goes with hair pulling. These two habits must be worked on together because they trigger off each other. Attempts to deal with one habit at a time don't work well.

Distinguishing between the hair pulling that is a comforting habit and hair pulling that is a tantrum is important. Ignoring the behavior will lead to less hair pulling only if it is being used in a tantrum. Attempts to stop it may inadvertently alert the child to the effectiveness of this behavior in upsetting the parent. If the hair pulling is a habit, ignoring it will allow the behavior to become more entrenched. Remove the child's hand from his hair and give your child interesting objects to play with or engage him/her in different activities.

Where the school age child is pulling their hair out as a reaction to circumstances, management involves searching for likely causes of stress, developing support systems and encouraging communication. It is helpful but not essential for the child to acknowledge what they are doing and participate in efforts to stop eg suggesting their own solutions, like a band aid in the thumb to make it harder to grip the hair. If the hair pulling is part of a repetitive ritualistic behavior, then the management plan would be to use approaches similar to those for OCD. This includes behavioral methods and medication, usually an antidepressant.

for more detailed descriptions of treatment options, check out the American Academy of Pediatrics  "Helping the Young Hair Puller" posted on kidsgrowth 02-26-07

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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