Hair Loss in Children & Adolescents

There are many congenital conditions that potentially affect normal hair growth, and with the possible exception of Alopecia areata, it’s infrequent for a child to be troubled with anything more than hair fall of a temporary kind.

When problems do arise, most can be treated successfully with simple alterations to the child’s diet and/or hair care routine. The most common childhood hair loss conditions that Trichologists or other health professionals would see are outlined here: (James: please use this as the summarized intro for this article)

‘Loose anagen/Short anagen syndrome’ is a temporary disorder of connective tissue competency where the hair can be painlessly pulled from the scalp with little effort. It may present as ‘diffuse’ (all over) hair loss or the visual appearance of trichotillomania. Loose anagen syndrome is most commonly seen in fair-haired girls between the ages of 2 and 9 years, but is sometimes seen in the elderly as well.

On visual inspection, no bulb or root sheath can typically be seen on the hair shaft. Microscopic examination reveals a bent hair shaft above a shrunken, under-developed or ‘sideways-twisted’ bulb.

Loose anagen syndrome is generally resolved with a short course of appropriate –nutrient-mineral therapy in combination with a topical nutrient treatment – the Activance Densify or Rhodanide range.

Assessing the child’s iron, Vitamin D, Zinc & Iodine (1) status is always prudent. A short course of Zinc at the appropriate dosage is often helpful. If deficiencies are found in a child with a nutritionally-sound diet – Gut dysbiosis (disturbance) causing malabsorption should be assessed (via faecal testing).

‘Delayed Growth Syndrome’ (aka: ‘Fail to grow’) of scalp hair or body hair (DGS) is thought to be a temporary delay in the growth response mechanism. Typically the child is female; fair-haired – and between the ages of 2 and 9 years, with fine fair hair of sparse density. Parents will often relate the child ‘has never required a haircut’or her hair has never grown beyond collar-length.

The problem is frequently corrected with dietary adjustments and some short-term nutritional supplementation – particularly an amino acid complex, iron & zinc. Increasing dietary protein intake, assessing (urinary) Iodine and Gut function (via CDSA ‘faecal’ test if required) may also assist.

Unless there are malabsorption issues or significant gut dysbiosis, both ‘Short/Loose Anagen’ & ‘Delayed Growth’ syndrome conditions usually recover – often without treatment intervention – by the time the child has reached puberty.

When poor dietary habits are extreme or have continued for a prolonged time, hair breakage, dull, dry hair, or excessive hair loss may eventually result. Teenage girls are most commonly ‘at risk’ here with fad dieting or inadequate consumption of iron-rich food sources. Simple advice on the value of the five food groups and commonsense eating habits is usually enough. A multi-vitamin/mineral supplement taken for 3-4 months will assist nutrient levels until a pattern of healthy eating is secured.

Where chronic scalp hair thinning and/or poor health persists, heavy metal toxicity should be assessed. Lead, Copper, Mercury, Aluminum and Cadmium are the main toxic heavy metals. Xeno-Oestogens which are synthetic oestrogens derived from petrochemicals should also be considered.

Alopecia areata may present in susceptible children of any age, and occasionally progresses to the more severe forms where all body hair is lost. (For a more complete description on alopecia areata, see the article ‘Alopecia areata & other autoimmune conditions’ at this site)

Alopecia areata is considered an inherited ‘autoimmune’ condition, when certain white blood cells begin reacting against the pigment (hair colour) cellswithin the hair shaft. That’s why initial hair regrowth in alopecia areata is nearly always white or unpigmented hair – these are spared by the immune system’s assault.

This disorder is more often seen in dark-haired and Asian people – affecting males and females equally (2). Two-five percent of children who develop alopecia are found to be gluten intolerant (gluten is the main protein of wheat). A study of Bangladeshi children experiencing alopecia areata found greater than 90% had developed antibodies to their thyroid gland.

Although anyone who develops alopecia areata has an inherited predisposition to do so, it’s believed some event is required to precipitate its activation. The more common triggers in children is disturbance of the Gut (termed: dysbiosis) – often resulting in malabsorption/mal-digestion problems. In the young gut of an atopic (3) child the immune system may become disorientated and mount an immune reaction against the skin and its appendages (hair follicles, nails etc.)

Other causes are illnesses of childhood, vaccinations, any food allergy – with dairy (lactose), gluten, or red fruits & berries being the common ones.

The practice of spray-on ‘temporary’ hair dyes for sporting carnivals or ‘muck up’ days is a regularly seen culprit for triggering juvenile alopecia areata in pre-disposed kids.

Sometimes where alopecia develops in early childhood it has a tendency to become more intractable and less responsive to therapy as time goes on. Severe alopecia areata can be very psychologically damaging, so investigation & treatment should be undertaken without delay.

Always encourage an optimistic attitude in the young person with respect to their condition. Whilst both the course of alopecia areata and its response to treatment is variable, complete hair regrowth can sometimes occur even in those with 100% scalp hair loss.

All treatments of demonstrated efficacy have their place, even so I prefer to begin with a detailed history and explore dietary adjustments – including challenging particular food groups if appropriate. In older children and adolescents, I usually suggest some specific pathology testing depending on the child’s age or their anxiety toward any invasive procedures.

An all-in-one nutrient therapy powder will optimise any deficiencies and be an across the board body support (3); Vitamin D and Zinc are the most important activators of hair follicle activity (Chan:2018).   

An organic sodium lauryl sulphate-free shampoo together with Activance Professional Densify-Rhodanide range compliments this combined non-drug, nutrient therapy approach.

Lastly, numerous trials using essential oil (aromatherapy) combinations have confirmed some success in the treatment of alopecia areata. Aromatherapy also reported far fewer adverse effects than is usually associated with customary dermatology treatments.

Traction alopecia is as the name implies, hair loss that occurs when the hair is held tightly under tension or ‘traction’, causing the hair shaft to be eventually extracted from the follicle. Traction alopecia is regarded as mechanical hair loss and is predominantly seen in females who continually pull their hair back in buns or ponytails. Here the problem presents as a ‘thinning’ of the hair behind the front hairline margins. This type of hair loss is also regularly seen with braiding or ‘dreadlock’ hairstyles.

Provided the styling practice is identified and redressed early, the lost hair will recover. Activance Rhodanide PF ‘Leave-in’ treatment or a short course of 3-5% Minoxidil topical gel or solution (4) or – together with some nutritional supplements will usually stimulate follicle hair growth back to its prior density.

It’s also important to educate the Client on revising their grooming/styling routine: don’t hold hair under tension (especially when wet) or sleep with their hair held tightly back. When hair is wet it has more ‘stretchability’, but shrinks as it dries – putting traction pressure on the hair follicle connective tissue.

Trichologists are now seeing increasing numbers younger males &females (16+) presenting hairline recession at the temples, and thinning scalp hair consistent with the appearance of androgenic alopecia (pattern hair loss). This can be quite devastating for the adolescent in terms of their self-confidence, and the youth’s parents who often express feelings of guilt for their teen’s condition.

Most young females reveal ‘acquired’ pattern thinning in that hair follicle miniaturisation is evident across the top of the scalp. This is usually due to nutrient-metabolic disturbance engaging compensatory mechanisms to maintain homeostasis.

Another initiating cause appears to be anti-acne prescription medication such as Roaccutane – a retinoic acid formulation. Whilst some medicos would dispute this, there is a very close cause – effect relationship. Roaccutane is also known to influence significant mood disturbance in pre-disposed teens, so parents should be acutely aware of this.

It also cannot be overstated how important it is to refer these young people and their parents to a qualified & experienced Trichologist or family doctor, who can identify the condition and provide accurate information on appropriate treatments.

Trichotillomania is a condition not uncommonly seen, where the child twists or plucks his or her own hair from the scalp. It sometimes begins as an unconscious act whilst concentrating or ‘day-dreaming’. It may also be the result of underlying anxiety in the child from a stressful home, school, or other social situation. Adult trichotillomania is considered an obsessive-compulsive disorder.

Affected areas have a ragged, uneven appearance where much hair breakage or empty hair follicles are evident. The crown area, behind the ears, or the oppositeside of the scalp to the dominanthand is usually the area that’s most ravaged. Image enhancement will readily show fractured hair shafts of uneven size and spread.

This should not be confused with the Exclamation Point hairs of alopecia areata. Young boys tend to have a higher incidence of trichotillomania than do girls of the same age. In adolescents & adults this ratio is heavily weighted to females.

“Always consider the Gut”; scalp hair thinning or hair loss; ‘fail to grow’ or Alopecia conditions in pre-primary school age children are (in my experience + opinion) commonly due to Gut disturbance (termed: Dysbiosis).

Approximately 90% of our immunity response defences lie along the gut wall and –as the immune system marshals to defend against gluten protein assault – auto- antibodies are produced (antigliadin/antiendomysial antibodies).

In the Gut of a young child the immune system can readily become disorientated and mount an immune reaction against the skin and its appendages (hair follicles, nails etc).

This is initially believed to be the result of ‘incompetent intestinal permeability’ of the Gut wall – often referred to as ‘Leaky Gut’ or ‘intestinal hyper-permeability’. Sensitivity to certain foods in the child’s diet – notably Gluten-containing foods (wheat, barley, rye, oats & hops), and Dairy products then begin to arise.

Gluten – the main protein of certain grains and Casein – Dairy protein – are large-structure proteins which the human gut was not intended to break-down and absorb. There may be other food allergies specific to the individual child such as peanuts, soy, mango, chemical food additives etc. – but Gluten and Dairy habitually prove to be the most common factors.

In ‘gluten-sensitive’ individuals, the phyto-protein Gluten is both toxic and destructive to their gut lining. Intestinal villi – the gut’s absorption mechanism – become scarred and obliterated; leaving the villi blunted or totally destroyed and seriously reduces the guts nutrient absorptive capacity. Malabsorption – and ultimately nutritional deficiency will arise from gluten sensitivity.

Although the most serious form of gluten sensitivity – Coeliac Disease – was considered uncommon, a 2000 study of symptomatic children found its incidence could be as frequent as 1:33 (Journal of Paediatrics 2000; 136:86-90).

Mothers of many atopic children intuitively know when their child is ‘wheat’ (Gluten), dairy (Lactose) intolerant or have other food sensitivities.

They describe changes in their child such as listlessness or general malaise, bloating, flatulence, distended abdomen, non-consistent bowel motions, pale pallor, darkening under the eyes, eczema flares or grizzly irritability in the child.

Gut function – and its capacity to optimally absorb nutrients – are significantly compromised in Gluten Enteropathy, antibiotic therapy, or when gut probiotics (gut microflora) is poor.

  1. A study by Eastman (2008) found 50% of all children of primary school age revealed Iodine deficiency to some degree.
  2. Research from the Mayo Clinic (Journal of Immunology, Nov.2004) illustrates that the male immune system is less reactive than the female, because testosterone slows & weakens T lymphocyte response. Though females are more susceptible to autoimmune disease (because of their lower levels of testosterone), a male’s immune response is blunted when faced with a similar threat because of their higher testosterone levels.
  3. Exclusive to Anthony Pearce Trichology through dedicated closed-to-the public pharmacy for ‘health regeneration through nutrition’. Nutrient therapy powder titrated to child’s age, weight + height.
  4. ’Atopic’ means the person affected has an increased sensitivity to their environment. Families who exhibit AA, scaling scalp conditions, thyroid dysfunction, and diabetes are examples of ‘atopy’.
  • Minoxidil appropriate for children 12 years and over, but still dependant on physical maturity, weight, height and any health or skin problems.

Copyright Anthony Pearce 2007 (revised September 2019)