Definition

• A nervous habit of twisting or pulling out the hair
• The medical name for this is trichotillomania

Health Information

Symptoms

• Frequent twisting of the hair
• Broken hairs of different lengths
• The missing hair occurs in patches of different shapes. This creates bald spots.
• Often occurs on the side of the head. In right handed children, the hair loss is usually on the right side.
• Rarely, it can include plucking of the eyebrows or eyelashes.
• Can occur with nail biting, lip biting or sucking, and sore picking habits.

Cause

• In young children, it’s simply a habit to comfort one’s self.
• In older children, it may be more of a habit to relieve tension.
• Often occurs when the child is thinking about something else.
• Teens with hair pulling may have OCD.

Care Advice

1. Overview:
   • Twisting the hair feels good to your child.
   • They often don’t know they are doing it.
   • Most young children outgrow it on their own.
   • Here is some care advice that should help.
2. Distract Your Child:
   • Often children twist their hair when they are bored or daydreaming.
   • When you see your child doing this, try to distract them.
   • Suggest they do something that will be fun
   • That will usually stop the hair pulling for now.
3. Treatment for Younger Children:
   • If your child is in a stubborn phase, do not comment on hair twisting. Reason: It may cause them to do it more rather than less.
   • This is how normal children react when they are 2 and 3. They are expressing their independence.
   • You don’t want stopping the hair twisting to become a control battle. Reason: You will always lose because it’s a rule you can’t enforce.
   • Caution: Never punish your child for hair pulling.
4. Treatment for Older Children:
   • This advice is for school age children
   • Offer them a substitute or competing habit.
   • An example is playing finger games. Pulling at a wool pad or squeezing an exercise ball are other options.
   • Caution: Never punish your child for hair pulling.
5. Remove Triggers:
   • Whenever your child has a flurry of hair twisting, try to find the cause.
   • Then try to remove or reduce that trigger.
   • Also, try to lessen any pressure your child may be under at that time.
   • Reason: Playing with the hair is used to reduce stress.
6. Relaxation:
   • Help your child relax in general.
   • Make sure your child has free time and fun time each day.
   • If your child has too many activities, try to lighten the schedule.
7. What to Expect:
   • Young children (age 4 to 10) with hair pulling usually get over it within 3 to 6 months.
   • Teens with hair pulling may need referral to a mental health expert for counseling.
   • Website for parents: www.trich.org

Call Your Doctor If

• It lasts more than 6 months
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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