Trichotillomania factsheet


There are many causes of patchy hair loss (alopecia). Trichotillomania is a condition where your child may feel an urge to twist, pull or pluck out their hair, eyebrows or eyelashes. Pulling the hair can give them a feeling of temporary relief.

Your child may pull their hair when they are stressed, or they may do it when they feel relaxed.

Trichotillomania can cause thinning hair or bald spots and the physical, emotional and social impacts of trichotillomania can be upsetting for your child.

Trichotillomania does not cause permanent hair loss or harm to the hair follicles. When the pulling, twisting or plucking stops, the child’s hair will grow back normally.

Trichotillomania is quite common in children and the behaviour responds well to treatment.

 Signs and symptoms

Signs that a child might have trichotillomania include:

  • thinning, uneven or one-sided hair loss or bald spots
  • suddenly losing a lot of hair
  • a lot of hair on the floor or pillows in the child’s room
  • constantly holding their hands near their head
  • wearing hats or other cover-ups because they don’t want others to see their bald spots
  • constantly looking in the mirror
  • low self-esteem
  • feeling ashamed about what they look like or because they can’t stop pulling out hair

There are often different reasons for the same behaviour at different ages.

Babies: 1 month to 2 years

Hair pulling at this age is usually a self-comforting habit. It often goes along with thumb sucking. The baby rests with thumb or fingers in their mouth and twists their own or their parent’s hair with the other hand.  The child finds this relaxing and usually does this before falling asleep or when they are distressed.

Toddlers: 2 to 5 years

If your child has been pulling at their hair since they were a baby, they will be in the habit of doing it without thinking.  At around the age of three, children can tell if you are reacting to what they do.  If you get worried or upset when your child pulls at their hair, they will soon learn how to get your attention with this behaviour. Hair pulling is used by your child as an effective addition to kicking and screaming during a tantrum. Younger children usually twist hair and older ones pluck at their hair.

School age: 5 to 12 years

Trichotillomania can be either a simple habit, an angry protest or a sign that your child is anxious or under stress. If your child starts pulling their hair out at school age, there may be other causes for the problem. It may be school-related stress or it can be a sign that something is worrying your child.

During this time, many children find it hard to put their troubles or feelings into words. This is more common in children who pull eyelashes or eyebrows. Children of this age become much more secretive about pulling out their hair. It may be hard to believe what is happening, if you don’t actually see your child do it. Trying to catch them doing it or frequent questioning will not help your child.

Adolescence: 12 to 18 years

Trichotillomania in adolescence is often similar to another childhood behaviour called Obsessive Compulsive Disorder (OCD). This can cause your child to develop troubling thoughts and rigid rituals. It may also be part of the adolescent struggle to be independent, an expression of rebellion or a symptom of anxiety.


Your child’s doctor will be able to make a diagnosis based on their signs and symptoms, or may refer you to a specialist child psychiatrist for diagnosis.

Before getting a diagnosis, children may also be tested for scalp infections or other medical reasons for their hair loss.


The treatment for your child will depend on what the underlying cause of the condition is. Your child’s doctor or health team will work out the most suitable treatment for your child.


Self-comforting habit

If the hair pulling is a habit, ignoring it will allow the behaviour to become more entrenched. You may remove the child’s hand from their hair and give them interesting objects to play with or engage them in different activities.

High risk times include when your child is tired, just before falling asleep, watching television and when bored (eg. during car travel).

Ideas that may help include:

  • a short haircut
  • hair net or cap to sleep in
  • cotton gloves or mittens for high risk times
  • give your child objects that feel like hair to play with, eg. pipe cleaners, satin ribbons or feathers. These can be swapped about to keep your child interested.
  • thumb sucking often goes with hair pulling.  These two habits must be worked on together because they trigger off each other. Trying to deal with one habit at a time doesn’t work well.

Part of a tantrum

Distinguishing between hair-pulling that is a comforting habit and hair-pulling that is part of a tantrum is important. If hair-pulling is part of a tantrum, ignoring the behaviour will lead to less hair-pulling. Trying to stop it may accidently let the child know that  the behaviour is upsetting you, and they may continue to do it.


When the school age child is pulling their hair out, it may be  a reaction to something that is worrying them. In this case, management involves searching for likely causes of the worry or stress, and developing support systems and encouraging communication. It is helpful but not essential for the child to acknowledge what they are doing and participate in efforts to stop. They may be able to suggest some of their own solutions - eg, using a band aid on their thumb to make it harder to grip the hair.

Repetitive ritualistic behaviour

If the hair-pulling is part of a repetitive ritualistic behaviour, then the management plan would be to use approaches similar to those for Obsessive Compulsive Disorder (OCD). This includes behavioural methods and medication, usually an antidepressant.

Last updated Monday 29th January 2024


This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024