Infant Hair Loss: Causes, What to Do, and How to Support Hair Growth

Newborn hair loss is a common and usually harmless phenomenon. Almost all newborns experience some degree of hair loss, leading many new parents to wonder about the causes and what they can do to support healthy hair growth. This article explores the various reasons for hair loss in babies, provides guidance on addressing it, and offers tips for promoting hair growth.

Is Hair Loss Normal in Babies?

It is perfectly normal for newborns to lose some or all of their hair. Many new babies are bald, although upon close examination of your baby's scalp, you will probably see pale, downy, extra-fine hair. This type of baldness can sometimes last until a baby's first birthday. Babies often lose their hair during the first six months. This kind of hair loss is called alopecia. The hair falls out and the new, mature hair hasn’t yet come in. The hair usually grows back within a year.

What Causes Hair Loss in Newborns?

Several factors can contribute to hair loss in babies:

Hormonal Fluctuations

A newborn's hormone levels fluctuate right after birth, which can cause them to lose the hair they were born with. (New moms often lose large amounts of hair for the same reason.) Thanks to the umbilical cord, the same hormones that were pulsing through your body during pregnancy and giving you that supermodel head of hair were pulsing through your baby’s, too. But after birth, those hormones drop, triggering hair loss in your baby - and even yourself.This phenomenon, called telogen effluvium, coincides with hair loss in new mothers and is an aftereffect of pregnancy hormones.

Friction

Hair rubbing against surfaces can also cause hair loss. If you notice that your baby has bald patches, observe the way they sit and sleep. If they always sleep in the same position or tend to sit with the back of their head against a baby seat, they may lose hair in that area. They may also develop a bald spot if they rub their head against their mattress. Hair’s the rub: Your baby may lose hair on the back of the scalp due to hair rubbing against the hard surfaces of crib mattresses, strollers, and playpens. (Experts recommend placing babies on their backs to sleep to reduce the risk of sudden infant death syndrome, or SIDS.) This hair loss is called neonatal occipital alopecia or simply friction alopecia.

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Medical Conditions

While less common, certain medical conditions can cause hair loss in babies:

• Tinea capitis (ringworm): Patchy bald spots with red, flaky scaling (and sometimes black dots where the hair has broken off) may mean that your baby has a contagious fungal infection called tinea capitis, or ringworm.
• Alopecia areata: If your baby has smooth, round, totally bald areas, they may have alopecia areata, a condition in which the immune system attacks the hair follicles, drastically slowing hair growth. This type of hair loss usually appears in isolated patches, although it can affect all of the hair on the body.
• Hypothyroidism or hypopituitarism: Some medical conditions - such as hypothyroidism (a thyroid disorder) or hypopituitarism (an underactive pituitary gland) - can cause hair loss all over your child's head.

Other Causes

• Physical damage: Physical damage - from tight ponytails, for example - can result in hair loss called traction alopecia.
• Trichotillomania: Irregular patches of hair may fall out if your older baby twirls or pulls their hair compulsively. This is called trichotillomania.
• Stress: Hair follicles are very sensitive to physical or emotional stress. The hair begins to fall out about 3-4 months after a severe stress. Reason: Hair follicles are very sensitive to physical or emotional stress. Examples are a high fever, severe illness or surgery. Also, an emotional crisis or a crash diet can be triggers. In pregnant teens, the stress can be childbirth. After hair stops shedding, the hair will slowly grow back. This can take 6 to 8 months for all the hair to grow back. The whole cycle takes about 12 months.

What Should You Do About Your Baby's Hair Loss?

In most cases, newborn hair loss is temporary and requires no specific treatment. However, there are steps you can take to address the underlying causes and support hair growth:

Adjust Sleeping Position

If the bald spot is the result of your baby spending too much time in the same position, try alternating the way your baby sleeps during naps and at night. If you usually put him to sleep with his head at one end of the crib, try putting him down with his head at the other end every other night. Your baby will naturally turn his head to the side to look out of the crib, so he'll be resting on a different part of his head.

Encourage Tummy Time

Make sure your baby spends some time on their tummy every day. In addition to giving the back of their head a break, tummy time is essential for your baby's overall physical development.

Consult a Doctor

Mention your baby's hair loss to his doctor, especially after your baby's 6-month birthday. Chances are the hair loss is normal, but their doctor can make sure that there isn't an underlying medical condition and help with treatment if there happens to be a problem. If your child has ringworm, for example, an antifungal medication will be prescribed. If the doctor suspects alopecia areata, you might be referred to a dermatologist for further evaluation. (Some children simply outgrow alopecia areata without treatment. Others - usually older children - receive medication to stimulate hair growth.)

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Handle Hair Gently

If breakage caused your baby's hair loss, you'll just have to treat his hair and scalp tenderly for a while until it grows back. (Keep in mind that a baby's hair is finer and more delicate than an adult's. Opt for natural styles and brush gently.)

How Can You Support Your Newborn's Hair Growth?

If all of your baby’s hair falls out, there’s not much you can do except wait for it to grow back. If your child does have some hair, you can support its growth by taking good care of it. Some tips include:

• Use gentle shampoo designed for babies. Only wash two or three times a week, not every day because that can dry out your baby’s scalp.
• Use a washcloth to gently shampoo your baby’s head, and don’t scrub.
• Use a soft bristle brush.
• Treat the hair gently.
• Wash the hair no more than once per day. Always use a hair conditioner.
• Comb the hair rather than brushing it.
• Be careful at combing out any tangled hair.
• Avoid any tight hair styles such as braids or a pony tail.
• Don't put tension on the hair.
• Stop using any ointments or oils in the hair. Reason: they block the hair follicles.
• Stop any hair style that puts tension on the hair. Reason: damages the hair follicle and makes it prone to infection.
• Wash any ointment or greasy pomade off the scalp with soap and water.

Pediatric Alopecia: An Overview

Alopecia (al·​o·​pe·​cia) means hair loss and alopecia in children can be caused by a variety of conditions. For most children, doctors can identify one of the following issues:

• Alopecia areata: This is a non-contagious hair loss condition thought to be caused by your child’s own immune system attacking his or her hair follicles. You may notice a sudden appearance of round or oval patches of hair loss that are smooth (no scaling or broken hairs).
• Endocrine problems: Hypothyroidism can occur in children and lead to hair loss. This is a condition in which the thyroid is underactive and not producing enough hormones to regulate metabolism.
• Non-medical hair loss: There are some causes of hair loss that will resolve on their own. Many newborns lose hair during their first few months, and this is replaced with permanent hair. Babies can also get bald spots from friction with a crib mattress or car seat. And children of any age can have mild hair loss from pulling the hair too tightly into ponytails or braids or brushing it roughly.
• Nutritional deficiency: This is a less common cause in children, but a deficiency in biotin or zinc - or excess vitamin A in the body - can lead to hair loss.
• Telogen effluvium: This condition can be caused by extreme stress (high fever, severe injury, surgery, death in the family, or reaction to some prescription medication) that interrupts the normal hair growth cycle. Hair follicles stop growing and, several weeks after the stressful event, you may notice your child’s hair shedding excessively - sometimes leading to partial or total baldness.
• Tinea capitis (ringworm): This is sometimes called “ringworm” (a fungal infection) of the scalp. You may notice round or oval scaly patches of hair loss on your child’s head, and the hair may be broken, leaving black spots on the scalp. This condition is contagious.
• Trichotillomania (trich or TTM): This non-contagious form of hair loss is caused by a child pulling, plucking or otherwise removing his or her own hair. You may notice patchy hair loss with broken hairs. This is frequently triggered by stress or anxiety.

Diagnosis of Pediatric Alopecia

To diagnose the cause of alopecia, your child’s doctor will examine his or her scalp for visible symptoms.

• Alopecia areata: is diagnosed through a physical examination and medical history.
• Endocrine problems: Hypothyroidism can be diagnosed through blood tests.
• Nutritional deficiencies: if suspected, can be diagnosed through blood tests.
• Tinea capitis (ringworm): is usually diagnosed by microscopic examination.
• Trichotillomania (trich or TTM): This is often diagnosed by ruling out other conditions, a physical examination, and a conversation about recent stressors.

Treatment of Pediatric Alopecia

There are a number of alopecia treatments, depending upon the type of condition for which your child has been diagnosed.

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• Alopecia areata: there is no cure, but treatment can often control the disorder. If your child is young, his or her doctor may prescribe strong corticosteroid ointments you can apply to bald spots. Other options include intralesional treatment, oral treatment, and topical immunotherapy. The first step in treatment is with creams or ointments or lotions (such as steroid medicines) applied to the bald spots to decrease the immune system activity in those areas. If the hair loss is widespread, it can be more difficult to treat. Luckily, new treatments are being studied all the time and some show good promise for more difficult alopecia areata. Other effective treatments include oral JAK( Janus kinase) inhibitors such as ritlecitinib (Litfulo) for people ages 12 and older, baricitinib (Olumiant) for people ages 18 and older, and deuruxolitinib (Leqselvi) for adults 18 years and older.
• Endocrine problems: If your child is diagnosed with hypothyroidism, a referral to an endocrinologist may be indicated. Treatment may involve medication prescribed by the endocrinologist to replace deficient hormones but will depend on a number of factors including: Your child's age, overall health, and medical history, Extent of the disease, Your child's tolerance for specific medications, procedures, or therapies, Expectations for the course of the disease, Your opinion or preference
• Nutritional deficiencies: If identified - can be treated with supplements, but speak to your child’s doctor first.
• Telogen effluvium: has no treatment, so your child’s doctor will follow up to ensure hair growth is restored.
• Tinea capitis (ringworm): If your child’s doctor diagnoses tinea capitis, he or she will prescribe an oral antifungal medication and an antifungal shampoo. Treatment usually involves an oral antifungal, such as griseofulvin taken by mouth for eight weeks. Your child should also use an antifungal shampoo such as selenium sulfide or ketoconazole to decrease shedding of the fungus.
• Trichotillomania: counseling and mental health care to break the habit may help stop it .

Hair Loss Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness).

• Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair.
• Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments and permanents.
• Stop smoking.
• If you're being treated with chemotherapy, ask your doctor about a cooling cap.

When to Contact a Doctor

Contact a doctor if:

• Hair does not grow back by 12 months old
• Hair does not grow back by 6 months after learning to sit
• Hair does not grow back by 6 months after hair style changed
• Hair does not grow back by 12 months after stressful event
• Scabs or crusts are present in the hair
• Ringworm of the scalp suspected.
• You have other questions or concerns

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