Child Started Pulling Hair Again? Parenting a Relapse
Has your child started pulling their hair again? Why setbacks are common in trich, what to do and say first, and when to go back to therapy for top-ups.
By The Trichotillomania Team · Last reviewed September 26, 2026
You’d watched the hair grow back. Now there’s a new thin patch, or hairs on the pillow, and your heart has sunk.
If your child has started pulling their hair again, you’re not alone, and neither are they. Trichotillomania (trich) is a condition where a person feels strong urges to pull out their own hair. It affects about 1 in 50 people, and setbacks are a common part of it. This guide covers why pulling comes back, what to do and say in the first few days, and how to tell whether it’s time to go back to therapy.
Is it normal for a child to start pulling their hair again?
Yes. Pulling that comes back after a good stretch is very common in trichotillomania, in children and adults alike. It doesn’t mean treatment failed or that your child isn’t trying.
Trich often runs in waves: quieter months, then a flare-up when life gets harder. Behavior therapy for trich is a talking therapy that teaches practical skills, like noticing the urge and doing something else with your hands. In adult studies, between half and two-thirds of people who responded well to it had relapsed by their last check-up, meaning their pulling had clearly increased again.
For children the picture looks a little brighter, though the studies are small. In a trial of behavior therapy for 7 to 17 year olds, most children who improved had kept their progress when checked again up to six months later, although some families didn’t take part in those later check-ups.
It can help to separate two ideas. A lapse is a short slip: a bad evening, or a stressful week. A relapse is when pulling settles back into a regular pattern over several weeks. A calm, practical response gives a lapse the best chance of staying small.
Why has the pulling come back?
Usually because something has changed. Stress often makes pulling worse, so a setback is often a sign that your child is carrying more than usual, not that they’ve stopped caring.
| What’s changed | Why it can bring pulling back |
|---|---|
| A new school year, exams, friendship trouble | Pulling often gets worse in stressful situations |
| A move, a new baby, separation, illness in the family | Big changes unsettle routines and raise stress |
| Puberty | Changing hormone levels may play a part |
| Tiredness, boredom, more screen time | Pulling slips in on autopilot when hands are free and the mind is idle |
| Hair growing back | Short, stubbly regrowth can feel “wrong” and invite pulling |
| The tools went away | Fidgets, barriers and tracking are easy to drop once things are going well |
Our complete guide explains why the regrowth stage can be a tricky time. Sometimes there’s no clear reason at all, and that isn’t something you missed.
What should I do when my child starts pulling again?
Stay calm, then quietly bring back what worked before. Your first reaction matters more than any single strategy, because shame and pressure tend to feed pulling.
- Pause before you react. Hold off on comments until you can speak calmly.
- Mention it once, kindly and in private. Choose a relaxed moment, not the second you spot a patch.
- Get the old plan back out. Put fidgets back where your child pulls, bring back the barriers that helped (a hat for TV time, a soft cap at night, finger covers), and ask whether they’d like to track their pulling again for a week or two.
- Look at what’s changed. Think about stress, sleep and routine. Easing the pressure can ease the urges.
- Don’t inspect or punish. Child psychiatrists advise that punishing hair pulling is unlikely to reduce it and can harm a child’s self-esteem. Checking their hair adds shame in the same way.
- Look after yourself. Feeling disappointed is normal. Talk it through with another adult, away from your child.
What should I say to my child?
Say little, say it kindly, and make it clear you’re on their side. Your child is probably already disappointed in themselves.
| Instead of | Try |
|---|---|
| “You were doing so well!” | “Setbacks are part of trich. You haven’t lost what you learned.” |
| “You’re doing it again. Stop.” | “Want your fidget?” (only if you’ve agreed this signal together) |
| “Why did you do that?” | “Has anything felt harder lately?” |
| “Let me see your hair.” | “I’m here if you want to talk. You don’t have to.” |
| “No phone if you pull.” | “What would help this week?” |
Praise effort rather than hair: using a fidget, telling you about a hard day, going to a session. Don’t be surprised if your child denies pulling at first. Children often hide or deny it to avoid punishment or embarrassment, and a calm, low-key tone makes it easier for them to be open with you.
Our guide to what to say (and not say) to a child who pulls has more example phrases. For the bigger picture, read 16 things parents of children with trichotillomania need to know.
Should we go back to therapy?
Often, yes, and it doesn’t mean starting from scratch. A few top-up sessions (sometimes called booster sessions) to refresh the skills are a normal part of care for trich.
Top-ups were built into one of the main research treatments for children. Eight weekly sessions were followed by four shorter visits and four phone check-ins over the next two months, and families were encouraged to get back in touch if pulling returned. Adult researchers suggest longer follow-up may help people keep their progress.
It’s worth booking sessions if:
- pulling keeps increasing even with the old tools back in place
- your child seems upset, withdrawn, or is avoiding things they enjoy
- your child asks for help
If your child has never had therapy, a setback is a good moment to start. The main approach is Habit Reversal Training, a form of behavior therapy that teaches a child to notice the urge to pull and do something else with their hands instead.
How can we make the next setback smaller?
Make a simple plan together now, while things are calm. In the trial of 22 children, therapy included regular meetings after the main treatment ended to help prevent relapse, and most children were still doing well six months later.
A one-page plan might include:
- Early warning signs, such as more hair touching, or pulling at bedtime again
- Risky times and places, like homework, screens or the bathroom mirror
- The tools that work best for your child
- What your child would like you to do, and what they’d rather you didn’t
- When to contact the practitioner
Keep it somewhere your child can find it, and look at it together before each new school year or any big change. Older teenagers may also find our guide to handling a relapse useful, as it’s written for the person who pulls.
When should I get more help?
Get help sooner if your child is very distressed, if pulling is spreading or taking up a lot of their time, or if you’re not sure what’s going on.
You can search our directory for practitioners who understand hair pulling, in person or online. Our guide to finding someone who understands trich explains what to ask on a first call.
For steady, practical support at home, there’s The Parent’s Guide to Trichotillomania: understanding what your child is going through.
If your child seems very low or hopeless, or talks about not wanting to be here, please get help today.
In an emergency, call 911 or go to your nearest emergency department.
- 988 Suicide & Crisis Lifeline — 988 (988lifeline.org)
Questions people ask
Did we stop therapy too soon?
Probably not. Pulling often returns at stressful times even after therapy has gone well. It’s more useful to treat a setback as a signal to refresh the skills than as proof that something was done wrong. A few top-up sessions with the same practitioner are a normal next step.
Is my child’s relapse my fault?
No. Nobody fully knows what causes trichotillomania, and child psychiatrists say plainly that neither parents nor children are to blame for it. Setbacks happen in families who have done everything right. What you can shape is how the setback is handled, and a calm, kind response helps.
My child says they’re not pulling, but I can see new patches. What should I do?
Don’t push for a confession. Children often hide or deny pulling to avoid punishment or embarrassment. Say once, gently, that you’ve noticed, that you’re not upset with them, and that you’re happy to help whenever they’re ready. Then let it go and keep the door open.
Should I tell the school the pulling has started again?
Only with your child’s agreement, and on their terms. If school stress is a trigger, a short, factual note to one trusted teacher can help, for example asking that a fidget is allowed in class. Most children want as few people as possible to know, so keep it small.
Will my child’s hair grow back after a relapse?
Usually, yes. Hair follicles are tough, and hair generally grows back once pulling eases, though it can take several months. Short new regrowth can itself trigger pulling, so keep barriers and fidgets close by while it grows.
Sources
- Franklin, M.E., Edson, A.L., Ledley, D.A. & Cahill, S.P. (2011). Behavior therapy for pediatric trichotillomania: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 763–771.
- Tolin, D.F., Franklin, M.E., Diefenbach, G.J., Anderson, E. & Meunier, S.A. (2007). Pediatric trichotillomania: Descriptive psychopathology and an open trial of cognitive behavioral therapy. Cognitive Behaviour Therapy, 36(3), 129–144.
- Welch, S.S. & Kim, J. (2012). DBT-enhanced cognitive behavioral therapy for adolescent trichotillomania: An adolescent case study. Cognitive and Behavioral Practice, 19(3), 483–493.
- Falkenstein, M.J., Rogers, K., Malloy, E.J. & Haaga, D.A.F. (2014). Predictors of relapse following treatment of trichotillomania. Journal of Obsessive-Compulsive and Related Disorders, 3(4), 345–353.
- Barber, K.E., Woods, D.W., Ely, L.J., Saunders, S.M., Compton, S.N., Neal-Barnett, A., Franklin, M.E., Capriotti, M.R., Conelea, C.A. & Twohig, M.P. (2024). Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania. Psychiatry Research, 333, 115767.
- American Academy of Child and Adolescent Psychiatry (2023). Hair pulling (trichotillomania). Facts for Families No. 96.
- NHS. Trichotillomania (hair pulling disorder).
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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