When to Take Your Child to a Doctor About Hair Pulling
Child hair pulling: when to see a doctor, who to see first, what they’ll check, and what to do if you’re told it’s alopecia. A practical guide for parents.
By The Trichotillomania Team · Last reviewed September 26, 2026
Noticing that your child is pulling out their hair can be frightening. This guide covers when to see a doctor, who to see first where you live, what they’re likely to check, and what to do if you’re told it’s alopecia. For the bigger picture of trichotillomania (trich) in children, see our guide for parents.
When should I see a doctor?
See a doctor about your child’s hair pulling once you’ve noticed it. You don’t need to wait until it’s “bad enough”. The UK’s NHS advises seeing a GP if you notice your child pulling their hair out, so other causes of hair loss can be ruled out.
Trichotillomania is a body-focused repetitive behaviour (BFRB): a condition where someone repeatedly pulls, picks or bites at their own hair, skin or nails. It affects about 1 in 50 people and usually starts around ages 10 to 13. It isn’t a bad habit or attention-seeking, and it isn’t your fault.
Ask for an early appointment if your child:
- swallows or chews pulled hair (see the box below)
- has sore, red, weeping or swollen skin where they pull, or red and sore eyes from pulling lashes
- seems very upset, is avoiding school or friends, or their mood has dropped
- has patches spreading quickly, or hair falling out without pulling
Hair pulling in babies, toddlers and preschool children is fairly common, often happens when they’re tired, and usually stops on its own. It’s still fine to ask a doctor to take a look. Our guide to toddler hair pulling covers this age group.
Who should I see first?
Start with your child’s usual family doctor, who can examine the hair loss and refer your child on if needed.
Start with your family doctor or your child’s paediatrician. They can examine the hair loss, rule out skin causes and refer your child on to a psychologist, a child mental health service or a dermatologist (skin doctor) if needed.
The treatment with the most research behind it is Habit Reversal Training (HRT), a type of CBT that teaches a child to notice when they’re about to pull and do something else with their hands. Experts writing about children stress that referral to someone trained in behavioural therapy for hair pulling should happen without delay.
What will the doctor check?
The doctor will ask about the pulling, look at the hair loss, and check for other causes. There is no single test for trich. Doctors diagnose it from what you and your child describe and what they see.
| What happens | Why |
|---|---|
| Questions about when, where and how your child pulls, and how they feel before and after | Trich is diagnosed mainly from this story |
| A look at the patches of hair loss, and at brows and lashes | Trich patches often have uneven edges and hairs broken at different lengths |
| A gentle tug on a few hairs near the patch (pull test) | Hair usually stays put in trich, but comes out easily in some other kinds of hair loss |
| A close look with a lit magnifier (trichoscopy) | Some signs seen this way are very specific to pulling |
| Sometimes, a check under a special lamp | To help rule out a fungal infection of the scalp |
| Sometimes, lab tests or a small skin sample (biopsy) | To rule out other causes if the picture isn’t clear |
Trichoscopy means looking at the scalp through a handheld magnifier with a light, called a dermatoscope. It’s quick and painless. A 2021 review of studies covering about 200 people with trich found several signs seen this way that were rarely seen in other kinds of hair loss, including alopecia areata. The authors recommended it as a standard part of diagnosis.
The doctor may also ask about mood and worries, because children with trich are more likely to have anxiety, low mood or OCD (obsessive-compulsive disorder). Our complete guide explains how trich is diagnosed.
What if they say it’s alopecia?
Ask what kind of alopecia they mean, and whether pulling has been ruled out. “Alopecia” simply means hair loss. The type most often confused with trich is alopecia areata, where the immune system causes round patches of hair to fall out.
The two can look alike. Doctors writing about children list alopecia areata, fungal infection, hair loss from tight hairstyles and shedding after illness as the main conditions to tell apart from trich. Even a biopsy can be hard to read, because the findings overlap.
If you’ve seen your child pulling, or found hair in their bed, say so clearly. If the diagnosis doesn’t fit what you see, or treatment for alopecia isn’t helping, it’s fine to go back or ask for a second opinion from a dermatologist who can use trichoscopy. Our guide to trichotillomania and alopecia compares the two in detail.
How do I prepare for the appointment?
- Write down what you’ve noticed: where on the body your child pulls, when it happens (bedtime, screens, homework), and roughly how long it’s been going on.
- Mention any hair eating, even if it’s only chewing.
- Talk to your child first, calmly and without blame. Let them know nobody is cross with them. There’s help with the words in our guide on what to say to a child who pulls.
- Ask the doctor directly: “Could this be trichotillomania?” and “Who can help with hair pulling around here?”
What happens next?
If the doctor thinks it’s trich, the next step is usually therapy with someone who understands hair pulling. Many doctors and therapists have never worked with a child who pulls, so it’s worth asking about experience. Our guide to finding someone who understands trich explains what to ask.
Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory by location.
While you wait, The Parent’s Guide to Trichotillomania can help you at home: understanding what your child is going through.
If your child seems very low or talks about not wanting to be here, get help today.
In an emergency, call your local emergency number or go to your nearest emergency department.
- Find a helpline (international directory) (findahelpline.com)
Questions people ask
Will the doctor tell my child off for pulling?
They shouldn’t. Trichotillomania is a recognised condition, not bad behaviour, and a good doctor will talk about it calmly. You can call ahead and ask for a doctor who is comfortable with children, or ask for a few minutes alone first to explain what’s been happening.
Should I tell my child before the appointment why we’re going?
Yes, in simple, calm words. Something like “we’re going to ask the doctor about your hair so we can find out what helps” is enough. Knowing what to expect makes the visit less scary, and it shows your child that nobody is cross with them.
Do I need photos of the hair loss?
Photos can help if the patches come and go, or if your child is shy about being looked at. Take them privately and only if your child is comfortable. A short note of when pulling happens and where on the body is often more useful than pictures.
Can a blood test show whether my child has trichotillomania?
No. There is no blood test or scan for trich. Doctors diagnose it from what you and your child tell them and what they see. They sometimes order tests to rule out other causes of hair loss, such as a fungal infection.
My child is only two. Is it worth seeing a doctor?
It’s reasonable to ask for a check if you’re worried, especially to rule out skin problems. Hair pulling in babies, toddlers and preschool children is fairly common and often stops on its own, so the doctor may suggest watching and waiting.
What if our doctor has never heard of trichotillomania?
That does happen. Bring a short written summary of what you’ve noticed and ask whether they could refer your child to someone who treats hair pulling. You can also look for a practitioner who understands trich yourself, in person or online.
Sources
- NHS. Trichotillomania (hair pulling disorder).
- Mayo Clinic. Trichotillomania: Diagnosis and treatment.
- Recabar, S. & Oakley, A. (2016). Trichotillomania. DermNet.
- Kaczorowska, A., Rudnicka, L., Stefanato, C.M., et al. (2021). Diagnostic accuracy of trichoscopy in trichotillomania: A systematic review. Acta Dermato-Venereologica, 101, adv00565.
- Sharifi, S., Estill, M., Tordjman, L., Millan, S.H. & Ouyang, J.X. (2026). Treatment strategies for pediatric trichotillomania: State-of-the-art review on progress and persistent challenges. Pediatric Dermatology, 43(1).
- Elston, D.M. (2019). Trichotillomania workup. Medscape.
- Cleveland Clinic (2025). Rapunzel syndrome: What it is, causes and symptoms.
- HSE. CAMHS referrals.
Is your child pulling their hair?
The Parent’s Guide to Trichotillomania walks you through what to say and what to do, step by step.
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