If the cause of the hair loss is mechanical, you can usually fix the problem. If rubber bands are breaking the hair, stop using them. If brushing vigorously is causing the hair to fall out, brush gently and occasionally. If your child has become a hair puller, talk to your doctor about strategies for changing this behavior. One approach is to cut the hair short enough that there isn’t much to grab.
If the alopecia is spontaneous, there is nothing you can do to minimize the hair loss. In time, the hair will likely grow back. If the hair loss is significant, hats, hairpieces, or wigs are all worth considering. Most toddlers are not self-conscious, but some will mention that the hair loss bothers them.
When does my doctor need to be involved?
Involve your doctor if your child’s scalp is irritated, itchy, or painful, or if it looks infected. If your child is pulling her hair, your doctor may be able to help you change the behavior.
If your child is experiencing long-lasting or recurrent alopecia, you will definitely want your doctor involved.
What tests need to be done, and what do the results mean?
A positive pull test proves that a child has active alopecia. This test is very simple: if hairs fall out easily with gentle traction at the border of the bald spot, more hair loss can be expected.
Sometimes your doctor will examine the hair to see if it is shaped like an exclamation point, with narrowing just before the root. This is typical of classic alopecia, but it does not always occur when alopecia is present.
What are the treatments?
Generally speaking, time is the best treatment for alopecia. In the vast majority of children, the hair will eventually grow back.
There are some treatments that may help stimulate hair growth, but these are rarely used in children and never in mild cases of alopecia. They include topical steroids, oral steroids, minoxidil (Rogaine), and nonsteroidal anti-inflammatory medications.
What are the possible complications?
There are really no medical complications of alopecia, but the cosmetic consequences and self-esteem issues that may arise are significant. Although toddlers tend to handle alopecia quite well, school-age children may have a harder time, as their peers can be insensitive to the problem.
In some patients with alopecia, the nails also become pitted. This usually occurs in the fingernails but not the toenails.