Trichotillomania: Hair-pulling in Children
By Kristie Rivers, MD, FAAP, Board Certified Pediatrician
Young children often show an interest in hair as they explore new textures. It’s common for children to go through a developmental stage of playing with their own hair or their caregiver’s hair. For a few children, however, hair becomes an obsession and can lead to severe uncontrollable hair-pulling, also known as trichotillomania.
Children with trichotillomania often pull hair from all over their bodies, including the scalp, eyebrows, eyelashes, arms, and legs. This often leads to bald patches in unsightly places and can cause embarrassment to an older child. Younger children may not even notice or be bothered by the hair loss.
It is not known why some children resort to hair-pulling. Many experts think boredom, stress, or anxiety are contributing factors. Others think this is a form of self-soothing or self-stimulation.
It is important for parents to remember that children cannot control this behavior. Punishing or shaming a child for hair-pulling can simply make matters worse and cause low self-esteem. Often, children will try to hide while they are pulling their hair out of shame and embarrassment, fearing they will be reprimanded and punished if caught.
Parents will often be asked to notice surrounding behaviors associated with hair-pulling, such as thumb- or pacifier-sucking. It is also helpful to note where the child pulls hair the most (in the bedroom when they are tired, while watching TV, in the car on the way to daycare or school) to give clues as to why the child may be pulling in the first place. Also it is important for parents to notice what the child does with the hair (e.g., wrapping it around the finger, playing with it, eating it).
Treatment is typically geared toward helping parents (or the children) recognize when they are pulling their hair and replace this act with alternate behaviors. Offering a reward system or a replacement for the hair-pulling are techniques often used with success. Using oral sensory substitutes such as a textured toys or teething rings can be of benefit. Often, treating trichotillomania involves the help of a behavioral therapist to get the behavior under control.
Psychiatric conditions such as anxiety, depression, and obsessive-compulsive disorder may also be associated with trichotillomania, so it is important for older children to be fully evaluated for additional conditions as well.
American Academy of Child & Adolescent Psychiatry
- Hair Pulling.
- For trichotillomania, try behavioral therapy before drugs.
Trichotillomania Learning Center
- Toddler and Pre-School Hair Pulling.
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