Q: Our 8-year-old daughter has gotten lots of compliments on her beautiful hair. Even the woman who cuts it has commented on how thick it is.
During the past few weeks, I've noticed a thin spot appearing on her right temple. At first I though I was imagining it; but now that area is almost bare.
I haven't mentioned it to her. I don't want to upset her. She's always teasing her father about being bald. What can be causing this in someone so young?
A: There is a long list of possible causes of hair loss (alopecia) in children, but only a few are common enough to mention.
Heading the list is a fungus infection of the scalp. If this is the cause of your daughter's hair loss, you may be able to see a scaly rash where her hair is thin.
This infection of the scalp is similar to the one causing ringworm or athlete's foot, but is usually more troublesome to cure because hair is involved.
Treatment requires medicine taken by mouth rather than an ointment or cream applied to the skin.
If you have been braiding your daughter's hair or her style requires pulling her hair back with some force, she may be experiencing "traction" alopecia, which is the result of prolonged tension on the hairs which may eventually damage the hair roots.
Sometimes children pull out hair as a nervous habit similar to nail-biting. Parents may not notice the hair pulling, and the child may not even be aware of it.
Some children have hair loss which cannot be attributed to one of these common causes or to an underlying medical condition. There is a pattern of hair loss called alopecia areata for which there have been theories, but no certain explanation. Its course is quite varied.
So we suggest that you tell your daughter what you have noticed. Ask her whether she has been pulling her hair. Whether she says "yes" or "no," we suggest that you reassure her that you are quite confident she is not being punished for teasing her father.
Then arrange to visit her doctor. If she does have scalp infection, prompt treatment may prevent spread to other areas of her scalp and to other children.
Dr. Wilson is director of pediatric primary care of the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.