Hair does not really serve any important function since a person can
certainly live without it! Yet, our hair and how it looks is a very important part of our
self-image. So when a child loses their hair, it is a disturbing event for both youngster
and their parents.
The life cycle of a single hair can be divided into a period of active
growth, lasting several years, and a resting stage, which last 60 to 90 days. Of the
normal scalp's 100,000 hairs, as many as 15 percent are in the resting mode, soon to be
lost at the rate of about 75 hairs per day (hardly noticeable to the child or parents).
The rate of hair loss does increase dramatically when the growing hair follicle is
subjected to different types of internal stress, such as high fever, severe flu, surgery,
crash diets, and certain medications.
Almost all newborns lose some if not all of their hair. This is normal and
is expected for the first six months, since the first hairs made by the infant's hair
follicles are usually silky and fragile. Occasionally, an infant will lose more hair on
the back of the head from constantly moving their head from side to side or spending too
much time on their backs.
Most abnormal hair loss in children is caused by one of five conditions:
alopecia areata, tinea capitis, traction alopecia, trichotillomania, and telogen effluvium
(Dermatologists love fancy names for their diseases!)
Tinea capitis or "ringworm" is a common cause of hair loss in
children. The condition is caused by a fungus (not a worm!) that invades the hair shaft
and causes the hairs to break. The bare patch of hair loss is often round and the scalp
takes on a black-dot stubble appearance from hair shafts broken off at the surface. There
may also be mild scalp itching and scaling. The condition is transmitted by contact from
one infected child to another by sharing combs, brushes, hats, barrettes, pillows and bath
towels. Minor bruising of the scalp occasionally provides an entry for the microscopic
fungus. Children three to ten years of are more susceptible and boys are more than girls.
Ringworm of the scalp is not dangerous. Without treatment, however, the hair loss can be
considerable and some children will develop a boggy tender swelling of the scalp known as
Tinea capitis is treated with an oral antifungal medication called
griseofulvin, usually taken for up to eight weeks. Selenium sulfide shampoo, used twice a
week, has been shorn to shorten the course of tinea capitis. Topical antifungal creams
usually do not help in killing the fungus and shaving the hair or giving the child a close
haircut is unnecessary. Even though the infection is still visible, a child with tinea
capitis may return to school after oral medication is started and the scalp receives at
least one washing with shampoo.
Alopecia areata (alopecia means "hair loss," areata means
"in patches") is another common form of patchy hair loss in children. The
typical story is the sudden appearance of one or more totally bald areas in the scalp. The
child with this condition loses hair in circular patches sometimes up to two inches in
diameter. The hair at the borders of these patches is loose, but the peach-colored scalp
looks and feels normal, without scaling or inflammation. There may be just a few patches
of hair loss or a total absence of body hair. Alopecia areata is not life-threatening, and
children who have it are otherwise healthy. Why the hair falls out from the roots is still
a mystery. What is known is that the condition is not contagious, caused by foods, or the
result of nervousness or psychological stress. In 20% of cases another family member has
been affected. Some patients with this condition will also develop a grid-like pitting of
Fortunately, over 80% children with alopecia areata grow new hair back
within twelve months. Oddly, the new hair may temporarily be white, but eventually the
hair returns to its natural color. Because the hair loss can sometimes be psychologically
devasting for the child, dermatologists have tried many different medications in an
attempt to stimulate new hair growth. Treatments sometimes involve cortisone injections
into the hair follicles.
Traction alopecia, or physical damage to the hair, is another common cause
of hair loss, particularly in girls. The human hair is quite fragile and really does not
respond well to the many physical and chemical assaults it has to endure in the name of
beauty. Constant teasing, fluffing, combing, washing, curling, blow drying, hot combing,
straightening and bleaching can do a number on the fragile hairs, causing them to fall
out, especially those by the hair line and along the front and sides. Styles that apply
tension to the hair, such as tight ponytails, braiding, barrettes, and permanent waving
can also damage the hair.
Treatment is to handle the hair gently, as little as possible, and use
natural hair styles. The hair will usually return, but regrowth can be slow. Injured hair
follicles do not heal quickly and often take three or more months before they are back to
their growing phase.
Trichotillomania is the compulsion to pull out one's own hair. It results
in irregular patches of incomplete hair loss, mainly on the scalp, but may involve the
eyebrows and eyelashes as well. The habit of pulling out one's hair is usually practiced
in bed before falling asleep or when the child is studying or watching television.
Interestingly, parents are usually not aware of the habit and frequently find it hard to
believe that their child would pull out their own hair. Affected areas of hair loss often
appear on the left side of right-handed children and on the right side of left-handed
youngsters. Most cases of trichotillomania resolve spontaneously. The best treatment is to
ignore the hair pulling and concentrate on why the child is anxious, nervous or
Another less common form of hair loss in children is called telogen
effluvium. Following a high fever, crash diet, flu, or emotional stress, hairs that were
in their growth phase suddenly are converted into the resting phase. Two to four months
later, when the child is otherwise fine and the stress is forgotten, these hairs begin to
shed and do so for about six weeks. The hair loss is not total or in patches- the hair
appears thin throughout the scalp. Unless the initial cause is repeated, all the hairs
normally return (telogen effluvium explains why many mothers lose so much hair weeks after
childbirth). Most parents who bring their child to the physician for this condition are
worried that the youngster has cancer or another bad disease.
Remember, hair loss in children is not caused from vitamin deficiencies
(at least in the United States), poor scalp circulation, headbands, hats, or helmets. When
children lose their hair, parents can probably make the diagnosis themselves. If they have
any doubts, they should consult with their child's physician.