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My 16-month-old daughter pulls out her hair. The pediatrician diagnosed her with trichotillomania/alopecia. What causes this?

Q: My 16-month-old daughter pulls out her hair. The pediatrician diagnosed her with trichotillomania/alopecia. What causes this?
A: Alopecia means hair loss. Trichotillomania means compulsively pulling out your own hair, on the head or elsewhere on the body. Trichotillomania is an impulse-control disorder, because the person who does it cannot stop the behavior at will. Some experts consider it a form of obsessive-compulsive disorder, but most seem to believe it is a separate, although related, condition.

Unfortunately, we do not know a whole lot about trichotillomania, especially among infants and very young children. The cause is unknown. It is possible that there is an inherited factor that is related to obsessive-compulsive disorder, but again, we are just not sure. Indications are that trichotillomania in children younger than 5 or 6 may be a different disorder than in older children and adults. Again, more research is needed. But the good news about hair-pulling at your daughter's age is that sometimes the behavior just stops.

When you go to the child psychologist, you should understand that, to date, treatment for this disorder has been experimental and based on trial and error. Make sure that the psychologist you see has experience dealing with trichotillomania in young children or at least has experience in behavior modification techniques with that age group.

Antidepressant and anti-anxiety drugs have been used with mixed success to treat trichotillomania, but I doubt your psychologist will commence treatment with medications. Drugs are not usually first-line therapy with young children because they rarely stand up to the risks-versus-benefits test. The condition does not cause serious physical harm and the emotional effects -- embarrassment, teasing, loss of self-esteem, etc. -- are not much of a factor at that age, either.

The psychologist may use some behavioral techniques or may suggest some modest changes that you can make with regard to reducing stress at home, or she may try to substitute alternate behaviors for hair-pulling. It really depends on the circumstances and the doctor's assessment. In some cases, professionals advise parents to simply ignore the hair-pulling for awhile to see if it goes away.

By the way, I assume your pediatrician has ruled this out, but I will mention it just in case it was overlooked. In rare cases of trichotillomania, the child pulls out the hair and eats it. This can be caused by an iron deficiency, so if you have seen your daughter doing this, a nutritional work-up is probably in order.