Playing with hair is a common activity for children and adults alike. There is considerable pleasure to be had from brushing, combing, twirling and curling hair. For many it is a self-comforting activity. In young children it is occasionally associated with thumb-sucking, and is also transient. In some children this leads to actually pulling hair out. This is not common, but it is distressing to parents when it does occur.

Cause

While there is uncertainty as to the exact reason why some children pull out their hair, in the majority of cases it is associated with stress, anxiety or other underlying psychological causes. It is seen more commonly in children who are mentally retarded, and those who are institutionalised. Sometimes there is an underlying scalp condition which can cause irritation and itchiness, and may make the hair more brittle.

Clinical features

There is wide variation in the clinical features. Most of these children continually twist and play with their hair, as if by habit. Some pull out single strands, others pull out whole clumps of hair. There is no predictable pattern with respect to frequency or duration. In many children there is other evidence of anxiety or depression, such as sleep problems, erratic appetite, social or school difficulties, and so on.

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