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Why is my child’s hair falling out?

How hair grows. 

In general, hair follicles go through three phases.  It starts with the growth phase, which may last up to 6 years.  The second phase is the rest phase, when the hair strand separates from the follicle, but doesn’t fall out yet.  This can last around 3 months.  The last phase is the shedding phase, where the hair is shed (up to 100 hairs a day), often while washing or brushing it.  While hair is shedding, new hairs are already growing in the follicles.    


At any one time, most hairs are in the growing stage, and only 10%-15% are in the rest or shedding phase.  Hair loss usually isn’t noticeable until 50% of it is shed.       


What is alopecia?

While many people think of alopecia as losing most of your hair, the true definition of alopecia is missing hair where there usually is hair.  So your doctor may call just a small amount of missing or thinning hair alopecia.  


Alopecia areata is an autoimmune disorder where the immune system attacks the hair follicles causing patches of missing hair, usually on the head. 


Alopecia totalis is when all the hair on the head is lost.  It’s probably the most common thing people think of when alopecia is discussed, even though it is very rare.  Even more rare is alopecia universalis, where all the hair on the body is lost.  Both of these are also thought to be autoimmune disorders.


What causes alopecia?   

The first hair that is lost in children is actually lost while still in the womb.  Lanugo is a fine silky hair that grows all over the baby, but falls out before birth.  


Telogen effluvium is a fancy name for a time when a large portion of hair follicles are pushed into the rest phase instead of the usual growth phase.  It’s usually triggered by some sort of stress, such as high fever, surgery, severe emotional upset, a crash diet, or childbirth.  Hair starts falling out about 3 months later, then slowly grows back in again in the next 6-8 months.  


Telogen effluvium is also the cause of the hair loss babies have their first year of life.  They generally lose it up to 6 months, then grow the new hair by 12 months.


Hairstyles can also cause alopecia.  Tight pony tails or braids are cute, but having them too tight for too long can damage the hair.  Rough hair brushing or combing as well as hot styling tools can also damage hair.  


Trichotillomania is when the child pulls out their own hair.  It can be any hair (head, eyelashes, etc), and can be bad enough that there are bald spots on the front or sides of the head where the child can reach.  Treatment may involve therapy, and sometimes medication.     


Ringworm is another common cause of alopecia.  When it is present on the head oral medication for several weeks is required to treat it.  


There are many other, usually less common, causes of alopecia.  These include abnormalities with the hair follicle or hair itself, lupus, some genetic diseases, some medications, or nutritional or hormone imbalances.  


Will my child’s hair grow back?

In many of the cases hair will grow back, although it may take up to a year.  In other cases, such as autoimmune, treatment may allow hair to grow back.  Other causes, like scarring, abnormalities of the scalp, or long term toxic medications, the hair loss will be permanent.


What do I do if I think my child has alopecia?

 The first thing you should do is make an appointment with your pediatrician.  They can look at the area and, along with a history of the problem, often make a likely diagnosis.  If not, then your pediatrician will refer you to a dermatologist.  


Can I give my child supplements to help their hair?

Some supplements may help your child’s hair, but blindly giving them isn’t the way to go.  Since hair is made from protein it is good to make sure your child eats a good amount of healthy protein.  With vitamins and minerals you have to be a little more careful as too much of some may actually hurt hair (eg Vitamin A and selenium), or cause false lab results (biotin).  Also, some kinds of alopecia may respond to different vitamins or minerals.  So, in general, if you are concerned about your child having a vitamin or mineral deficiency causing their alopecia, ask your pediatrician or dermatologist.  If you feel like you need to give your child something, then a regular multi-vitamin is the best choice, not a ‘hair supplement.’


Bottom line.

Children sometimes have alopecia.  Most of the time it gets better on its own.  In the cases that it doesn’t, your pediatrician and/or dermatologist may be able to help.  Also, give a multi-vitamin instead of hair supplements because too much of some vitamins and minerals may not help at the least, and hurt at the worst.



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