Baby hair loss

Hair loss also called alopecia in children can be quite normal. Many babies are bald from birth, or lose their hair shortly afterwards. Almost all newborns lose some or all of their hair. This is normal and to be expected before your baby’s permanent hair starts growing. The baby hair falls out before the mature hair comes in. So hair loss occurring in the first six months of life is not a cause for concern.

Also very commonly, healthy babies often have bald patches at the backs or sides of their scalps. This is because they lie on their backs a lot of the time, so their heads often rub against something like the mattress or as a result of a head banging habit. This type of hair loss is also called friction alopecia or pressure alopecia. Repeated or severe friction can cause hair loss at any age. Your baby’s hair will grow normally when he can spend more time sitting up.

Many babies also lose hair on the back of the scalp at age four months as their hair grows at varying times and rates. In very rare cases, babies may be born with alopecia (hair loss), which can occur by itself or in association with certain abnormalities of the nails and the teeth. Later in childhood, hair loss may be due to medications, a scalp injury, or a medical or nutritional problem.

An older child may also lose her hair if it’s braided too tightly or pulled too hard when combing or brushing. Some children (under age three or four) twirl their hair as a comforting habit and innocently may pull it out. Other children (usually older ones) may pull their hair out on purpose but deny doing so, or they simply may be unaware that they are doing it; this often is a signal of emotional stress, which you should discuss with your pediatrician.

Alopecia areata, a condition common in children and teenagers, seems to be an “allergic” reaction to one’s own hair. In this disorder, children lose hair in a circular area, causing a bald spot. In general, when it’s limited to a few patches, the outlook for complete recovery is good. But when the condition persists or worsens, steroid creams and even steroid injections and other forms of therapy at the site of the hair loss often are used. Unfortunately, if the hair loss is extensive, it may be difficult to renew its growth.

Because alopecia and other types of hair loss can be a sign of other medical or nutritional problems, bring these conditions to your doctor’s attention whenever they occur after the first six months of age, seeing your doctor can help you rule out any cause for concern. Your doctor will look at your child’s scalp, determine the cause, and prescribe treatment. Sometimes, a referral to a pediatric dermatologist is necessary.

Newborn normal hair loss in infancy key points

• Newborns are born with varying amounts of hair.
• The baby hair of many newborns falls out during the first 6 months of life. Hair loss peaks at 3 months old. The mother may also lose some of her hair at this time.
• This baby hair is then replaced by permanent hair.
• The normal hair comes in between 6 and 12 months.
• This shedding phase in newborns is always normal.
• Hair loss is not caused by shampoos.

Hair loss on back of head from chronic rubbing and friction key points

• Babies can rub off a patch of hair on the back of the head. This most commonly occurs in infant 3 to 6 months old.
• The hair loss is from friction during head-turning against a firm surface. Examples are crib mattresses, playpens, activity mats and infant seats.
• The hair grows back once the baby starts to sit up.
• This may take 6 to 12 months.
• Can also occur in any bedridden child (e.g., severe cerebral palsy).

Baby hair loss causes

Causes of hair loss or alopecia:

• Normal hair loss.
  • Newborn hair loss – The hair of many newborns falls out during the first few months of life. This baby hair is replaced by permanent hair.
  • Rubbing or friction. Babies can rub off a patch of hair on the back of the head. This most commonly occurs in infant 3 to 6 months old. It is a result of friction during head-turning against a firm surface. Examples are crib mattresses, playpens, and infant seats. The hair grows back once the baby starts sitting up. Also called friction alopecia or pressure alopecia. Repeated or severe friction can cause hair loss at any age.
• Abnormal hair loss: There are several causes of abnormal hair loss in children and teenagers.
  • Ringworm of the scalp (tinea capitis) is a common cause of abnormal hair loss. This is the main cause of patchy hair loss that needs medical treatment. Your child’s doctor will prescribe a medicine to treat ringworm of the scalp. It’s taken by mouth.
  • Alopecia areata is a common skin condition that causes hair loss from different parts of the body. It doesn’t scar, but older children can feel distressed if they lose hair from large or noticeable areas.
  • Tight hair styles also known as traction alopecia, mechanical alopecia, or “hair abuse”. If hair is pulled too tight, it will eventually break. This gives a frizzy look from hairs broken off at various lengths. Mostly seen with tight braids, pony tails or dreadlocks (especially corn row styles). Hair loss can also occur during exercise while wearing head phones.
  • Some children might have incomplete hair loss in areas of their scalp because of vigorous hair-brushing or back combing. This is because of immature hair follicles and because the hair shaft is poorly attached to the scalp. This pattern of hair loss will sort itself out gradually as your child grows. Hot hairstyling tools can also cause hair damage.
  • Older children might pull out their hair as a kind of nervous habit. Some children pull at their eyebrows and eyelashes also. This nervous habit is called trichotillomania and can be a sign of an emotional disorder. Frequent twisting of the hair results in broken hairs of different lengths. The missing hair occurs in patches of different shapes. This creates bald spots. Rarely, it can include plucking of the eyebrows or eyelashes. Can occur with nail biting, lip biting or sucking, and sore picking habits. In older children, may be associated with OCD.
  • Stress is called telogen effluvium. Hair follicles are very sensitive to physical or emotional stress. Examples are a high fever, severe illness or surgery. Also, an emotional crisis or a crash diet can be triggers. In pregnant teens, the stress can be childbirth. The hair begins to fall out about 3-4 months after a severe stress. After hair stops shedding, the hair will slowly grow back. This can take 6 to 8 months for all the hair to grow back. The whole cycle takes about 12 months. There’s no way to hurry the process. The hair growth cycle needs to run its course. What to expect:
    • No more than 50% of the hair will be lost.
    • Once the hair starts to regrow, all the hair will grow back in about 6 months.
    • The new hair will look normal.

Hair loss is not caused by shampoos.

If you notice your child’s hair thinning, it could be a sign of thyroid gland problems. Thyroid disease is rare in children, but if you notice this symptom, discuss it with your doctor.

Hair loss prevention

Be careful when combing, brushing and shampooing your child’s hair, because pulling too hard on hair shafts can cause hair loss. Also, try not to make ponytails or pigtails too tight. And avoid using hair straighteners or chemicals on your child’s hair.

Hair loss symptoms

The main symptom of hair loss is a bald or thinning patch.

If your child has ringworm or impetigo, she/he might complain of an itchy or tender scalp too. With ringworm, you might also see some redness and scaling in your child’s bald patch, as well as some short, dull and bent hairs, which are only a few millimeters in length.

If your child has alopecia areata, the patch will be completely bald, and the scalp won’t have any signs of scaling, redness or scarring. It isn’t itchy or tender. This condition can happen anywhere on the scalp, eyebrows, eyelashes or hairy areas of the body.

In trichotillomania, the bald patches are usually at the front or side of the scalp. The patches are never completely bald, might be an irregular shape, and will have hairs of different lengths.

Hair loss from tight hair style symptoms include broken hairs are seen at the hairline or where the hair is parted. It’s usually the same on both sides of the head.

Hair loss after stress symptoms include lots of hair is noticed in a comb or brush. The hair falls out from all parts of the scalp. This leads to major thinning of the hair, but no bald spots.

Hair loss diagnosis

A careful history and full skin examination can generally result in the correct diagnosis. Additional tests may include:

• Hair pull test to determine the relative proportion of anagen and telogen hairs
• Wood lamp examination
• Swabs of pustules for bacterial and viral culture
• Skin scrapings and hair clippings for mycology
• Blood tests for hematology, thyroid function, serology.

Hair loss treatment

Treatment for hair loss involves treating the underlying cause, and reassuring your child that the hair will regrow and won’t cause scarring.

Small patches of alopecia areata that don’t grow in size can sort themselves out without treatment. If your child’s bald patches are getting worse, your doctor might prescribe corticosteroid cream or another treatment for a few weeks.

Treatment for hair loss from friction and too much time on back:

• After 1 month old, give your baby more tummy time.
• Caution: Tummy time should always occur under adult supervision. Reason: Risk of suffocation until child reaches an age when can turn over.
• Tummy time has many benefits.
• It will help the back of head become more rounded and less flat.
• It will also build up strength in shoulder muscles.

Treatment of broken hairs from tight hair style:

• Change the hair style to one that doesn’t put tension on the hair.
• If that is not acceptable, loosen the ponytail or braids.
• These hair styles are at risk if they feel tight or cause any pain.
• Outcome: If tight hair styles are avoided, the hair will return to normal.
• Warning: If tight braiding continues over 10 years, permanent hair loss can occur.

Hair loss after stress hair care:

• Treat the hair gently.
• Wash the hair no more than once per day. Always use a hair conditioner.
• Comb the hair rather than brushing it.
• Be careful at combing out any tangled hair.
• Avoid any tight hair styles such as braids or a pony tail.
• Don’t put tension on the hair.
• No special shampoo or cream is needed or helpful.
• See your doctor if your hair does not grow back by 12 months after stressful event.