Why is my child losing hair? The common causes

Finding a bald patch on your child's head can be unsettling. This guide covers four causes: scalp ringworm, alopecia areata, tight hairstyles and hair pulling. Each one looks a little different, and each is handled differently.

Ringworm is a fungal infection that most often affects children. ¹ Alopecia areata typically causes small, round patches, usually without a rash. ⁵ With tight styles, the hairline is one of the first places hair loss shows. ³ Hair pulling tends to leave an uneven look. ⁴

Scalp ringworm: an infection that spreads

Ringworm of the scalp is also called tinea capitis. It is caused by mold-like fungi called dermatophytes, not a worm. ¹ MedlinePlus says it most often affects children and goes away at puberty. It can still occur at any age. ¹

Ringworm can spread quickly. ¹ It passes by direct contact with an area of ringworm on someone else. ¹ It can also spread through shared combs, hats or clothing, and from pets, particularly cats. ¹

The affected areas may look like this:

• Bald, with small black dots from hairs that have broken off. ¹
• Round, scaly patches of skin that are red or swollen. ¹
• There may be pus-filled sores called kerions. ¹

A child may also have a low-grade fever or swollen lymph nodes in the neck. ¹

A health care provider will look at the scalp for signs of ringworm. They may also check a skin scraping under a microscope. ¹ The provider will prescribe medicine taken by mouth, and MedlinePlus says it is taken for 4 to 8 weeks. ¹ A medicated shampoo may slow or stop the spread. It does not get rid of ringworm. ¹ Other family members and pets should be examined and treated, if necessary. ¹

MedlinePlus also notes that ringworm may cause permanent hair loss and lasting scars. ¹ It advises that no one in the home share combs, hairbrushes, hats, towels, pillowcases or helmets. ¹ The Balds guide to scalp ringworm covers the other home steps.

Alopecia areata: round, bare patches

Alopecia areata happens when the immune system attacks hair follicles, the structures in skin that form hair. ⁵ In most cases, there is no obvious trigger. ⁵ It can begin at any age, but most people get it in their teens, twenties or thirties. ⁵

Hair typically falls out in small, round patches about the size of a quarter. ⁵ There is usually no rash, redness or scarring on the bare skin. ⁵ Around the edges, there are often short broken hairs called "exclamation point" hairs. These are narrower at the base than the tip. ⁵ Some people say they feel tingling, burning or itching just before the hair falls out. ⁵ Any body part may be affected, including the eyebrows or eyelashes. ⁵

A board-certified dermatologist can often diagnose it by looking carefully at the patches and the nails. ² They will also ask whether close blood relatives have alopecia areata. ²

The American Academy of Dermatology says treatment is not always recommended. ² For one or two bald spots there for less than one year, a dermatologist may suggest waiting to see. ² The AAD says many people, especially children, regrow their hair without treatment. ² Regrowth can be slow, and some people do not see the regrowth they expect. ² New hair may look white or gray at first. It may regain its natural color over time. ⁵

The course is hard to predict. NIAMS says that when it starts in children younger than age 10, it tends to be more extensive and progressive. ⁵ Sometimes hair regrows in one patch while new bare patches form. ⁵ Some people have bouts of hair loss throughout their lives, while others have only one episode. ⁵ There is more in alopecia areata: patchy hair loss explained.

Tight hairstyles: traction alopecia

Traction alopecia is hair loss from hairstyles that pull. ³ The American Academy of Dermatology says children can get it too. Styling habits that can lead to hair loss often begin at a young age. ³ Some people get it more often because tight styles are common in their culture. The AAD says this is especially true for girls and women of African descent. ³

When they are too tight, risky styles include pulled-back buns, ponytails and updos, cornrows, and weaves or extensions. ³ Signs to look for include patches of hair loss where hair is pulled tightly. Another is "tenting," where sections of scalp are pulled up like a tent. ³ If a style feels painful, the AAD says it is too tight. ³

The AAD suggests ways to reduce the pulling:

• Loosen braids, especially around the hairline. ³
• Choose thicker braids and locs, and keep them short. Longer hair is heavier and pulls more. ³
• Switch styles regularly so the hair can recover. ³

Timing matters. If the pulling continues, most people eventually notice their hair stops growing. Shiny, bald skin is left behind. ³ At that stage, the AAD says, the hair cannot grow back. ³ See traction alopecia from tight hairstyles for more.

Hair pulling: trichotillomania

Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. ⁴ People are unable to stop, even as their hair becomes thinner. ⁴ MedlinePlus calls it a type of obsessive-compulsive and related disorder. Its causes are not clearly understood. ⁴

Symptoms most often begin between the ages of 11 and 13. ⁴ Hair may come out in round patches or across the scalp, giving an uneven look. ⁴ A child may also pluck eyebrows, eyelashes or body hair. ⁴ Regrowth in the bare spots can feel like stubble. ⁴ There may be a growing sense of tension before pulling, and relief afterward. ⁴

MedlinePlus says trichotillomania that begins in children younger than 6 may go away without treatment. ⁴ For most people, it adds, the hair pulling ends within 12 months. ⁴ For others, it is lifelong. Even then, treatment often improves the pulling and feelings of depression, anxiety or poor self-image. ⁴ Behavioral therapy and habit reversal may also be effective. ⁴ The Balds guide to trichotillomania goes into more depth.

The four side by side

When to see a doctor

The AAD says it is never too early to see a board-certified dermatologist about hair loss. ³ A dermatologist can diagnose the type of hair loss. ³ That matters here, because these causes are handled so differently.

It is worth booking a visit if you notice:

• Scaly, red or swollen patches, black dots, or pus-filled sores. These can be signs of ringworm. ¹
• A low-grade fever or swollen lymph nodes in the neck along with scalp patches. ¹
• Painful styles, tenting, or patches where hair is pulled tightly. ³
• A child eating the hair they pull out, which can cause a bowel blockage. ⁴
• Small patches joining to form larger ones. ⁵

For ringworm, MedlinePlus also says to contact a provider if home care is not enough. ¹ Some people with alopecia areata may be at risk for other autoimmune diseases. The AAD says that makes it important to keep dermatology appointments. ² The guide to seeing a dermatologist about hair loss explains what to bring.

Looking after how your child feels

Hair loss can feel bigger to a child than it looks to anyone else. A calm, matter-of-fact tone helps. NIAMS notes there are resources to help people cope with hair loss. ⁵ With hair pulling, MedlinePlus says decreasing stress can help, because stress may increase compulsive behavior. ⁴

Not every child wants to hide their patches. The AAD notes that some people prefer to shave, rather than cover up a patchy look. ² Others choose not to treat at all. If hair does not come back, that is a real and acceptable outcome. NIAMS says most people with alopecia areata are healthy and have no other symptoms. ⁵

General information, not medical advice. This article was drafted with AI assistance and checked against the sources listed above. Nobody at Balds is a doctor. If something here is wrong or out of date, tell us.