Hair loss in children

Overview

Hair loss in children, also called pediatric alopecia, is when a child loses hair from the scalp or other parts of the body. It can happen suddenly or slowly, and it may be temporary or longer lasting.

Hair loss is not very common in children, but it does occur. Many cases are mild and get better on their own.

It can affect children of any age, but certain types like alopecia areata are more common in school-age children. Both boys and girls can be affected.

Symptoms

Common symptoms

• Patchy bald spots on the scalp
• Thinning hair all over the scalp
• Broken hairs that look like black dots
• Scalp scaling, redness, or itching

Symptoms in children

• Children may have round, smooth bald patches.
• Hair may break easily or fall out when gently pulled.
• Some children feel itching or discomfort on the scalp.
• In ringworm, there may be a black-dot pattern and broken hairs.

Symptoms in older adults

• This article focuses on children. Hair loss in older adults usually has different causes, such as aging or hormone changes.

Causes

Main causes

• Ringworm of the scalp (tinea capitis) – a fungal infection that causes scaly bald patches.
• Alopecia areata – the immune system attacks hair follicles, leading to patchy hair loss.
• Telogen effluvium – temporary shedding after a stressful event like illness or fever.
• Traction alopecia – hair loss from tight hairstyles such as braids, ponytails, or extensions.
• Trichotillomania – a condition where a child pulls out their own hair, often due to stress or habit.

Risk factors

• Family history of alopecia areata or autoimmune diseases.
• Having a weakened immune system.
• Frequent use of tight hairstyles or hair accessories.
• Exposure to a child with ringworm or using shared combs and hats.

When to see a doctor

See a doctor urgently if:

• Your child has hair loss along with a fever, severe headache, or large patches of hair falling out at once.
• The scalp has open sores, pus, or severe swelling.

Book a routine appointment if:

• You notice small bald patches or gradual thinning of your child's hair.
• Your child pulls out their hair, or you suspect trichotillomania.
• Your child has itching or scaling on the scalp that does not go away.

Diagnosis

A doctor will ask about your child's health and medical history and examine their scalp. They may gently pull on a few hairs to see how easily they come out. The doctor may also look at the hairs under a microscope.

Tests that may be done

• A small sample of hair or skin may be taken (biopsy) to check for infection or inflammation.
• A fungal culture (swab of the scalp) to test for ringworm.
• Blood tests to check for immune system problems or nutritional issues.

What to expect at your appointment

The diagnosis is usually straightforward. The doctor will explain the likely cause and discuss next steps. Many conditions are diagnosed based on the pattern of hair loss and physical exam.

Treatment

Treatment depends on the cause. Many types of hair loss in children get better on their own. For infections, antifungal medications are used. For alopecia areata, creams or light therapy may help. For trichotillomania, therapy can help. Always follow your child's doctor's advice.

Self-care at home

• Use mild, gentle shampoos and conditioners.
• Avoid tight hairstyles like braids, ponytails, or hair extensions.
• Keep the scalp clean and dry.
• Encourage a balanced diet with plenty of protein, iron, and vitamins.
• Help your child manage stress through play, exercise, or talking.

Medical treatments

For fungal infections (ringworm), doctors often prescribe antifungal shampoos and oral medications. For alopecia areata, they may recommend creams that calm the immune system or light therapy. For trichotillomania, behavioral therapy or counseling can be effective. Specific medications should only be taken under a doctor's guidance.

When is surgery considered?

Surgery is rarely needed for hair loss in children. In very rare cases of scarring alopecia, a hair transplant might be considered after the child has stopped growing. This is not common.

Living with this condition

Hair loss can be upsetting for a child. Talk to them about their feelings and reassure them. Use a soft brush and avoid heat styling. Protect the scalp from the sun with a hat or sunscreen.

Lifestyle tips

• Use gentle hair care products without harsh chemicals.
• Avoid pulling or twisting hair as a habit.
• Try a shorter haircut if longer hair is causing pulling or breakage.
• Use a hair net or scarf during sports to reduce friction.

Diet and exercise

A balanced diet with enough protein (like eggs, fish, beans), iron (spinach, red meat), and vitamins (especially B vitamins) supports healthy hair growth. Regular exercise helps reduce stress and improves overall well-being.

Mental health and emotional wellbeing

Hair loss can affect a child's self-esteem and may lead to anxiety or sadness. They might worry about how others see them. It is important to listen, offer comfort, and seek help from a school counselor or therapist if needed.

Prevention

Not all types of hair loss can be prevented, but you can reduce the risk of some causes. Avoid tight hairstyles, keep the scalp clean, and treat scalp infections early. Teach your child not to share hats, combs, or brushes.

Vaccines

There are no vaccines to prevent hair loss.

Screening programmes

No routine screening is needed. If you notice hair loss, see a doctor for evaluation.

Complications

If left untreated

• Untreated fungal infections (ringworm) can spread to other parts of the body or to other people.
• Some types of hair loss, like traction alopecia, can cause permanent damage if tight hairstyles continue.
• Emotional distress, low self-esteem, and social anxiety may worsen without support.

Long-term outlook

Most children with hair loss will see their hair grow back, especially with proper treatment. Even for chronic conditions like alopecia areata, hair often regrows on its own. With patience and support, children can lead happy and confident lives.

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