My grandson keeps pulling his hair out - what can we do to stop the terrible bald patches?
- Trichotillomania means repetitive hair-pulling which can lead to bald spots
- The habit is normally harmless, and most children are likely to outgrow it
- But if this occurs often and persistently, it can affect the child's well-being
My grandson is eight years old and, for some time now, he has twiddled his hair. But now he is pulling hair out and has bald patches which look terrible.
What can we do to stop him?
Name and address withheld.
Trichotillomania is where someone pulls, twists or plucks their hair in a repetitive way, leading to patches of obvious hair loss
The condition you have described is called trichotillomania.
This is where someone pulls, twists or plucks their hair in a repetitive way, leading to traction alopecia — patches of obvious hair loss as a result of the hair being pulled under strain.
Overly tight ponytails can also cause traction alopecia.
Most children develop repetitive behaviours at some stage, perhaps because they find them comforting.
Typically these habits, such as thumb-sucking or nail-biting, are harmless and the child grows out of them eventually.
Whether they are considered abnormal depends on how often and how persistently they occur, and their effect on the child’s emotional and social well-being.
The fact that your grandson has obvious bald patches suggests he has a habit disorder that needs treatment.
Although trichotillomania does not usually interfere with physical health or everyday functioning, it might lead to teasing or bullying at school.
It may also be a sign that he has another associated problem that is not yet apparent, such as obsessive compulsive disorder, so some form of action is required.
Most children develop repetitive behaviours at some stage, perhaps because they find them comforting. Typically these habits are harmless and the child grows out of them eventually
What’s more, it could prove too frustrating for you all to try to train him into breaking the habit himself, so it would be far better to obtain professional assessment and accept the help offered.
It would, therefore, be advisable to consult a paediatrician, child psychologist or child psychiatrist — your family doctor should be able to arrange a suitable referral.
One option that a child psychologist might try with him is a habit reversal technique.
This involves teaching the child to substitute a different behaviour for the hair twiddling, such as gently clasping one earlobe between thumb and forefinger.
But before that, a diagnostic assessment is paramount, to be certain there are no other, less obvious problems in his psychological or emotional life.
I have pernicious anaemia. I had vitamin B12 injections every three months for 24 years until I was 64.
I was told originally it would be for the rest of my life and specialists say you cannot get better from pernicious anaemia.
But my doctor cut down the injections from four yearly to two yearly — then told me I didn’t need them at all. Your thoughts please.
Mrs J. J. Sinnott-Martin, Spalding, Lincs.
How confusing. The reasons for the change of advice over your vitamin B12 injections remain unclear — as you say, the diagnosis of pernicious anaemia implies that the condition is lifelong.
First, I shall explain the condition for the sake of other readers.
Pernicious anaemia can have various causes. Essentially, it develops if someone becomes unable to absorb vitamin B12 from food (a nutrient only found naturally in foods of animal origin, including meat, poultry, eggs and fish).
The vitamin is absorbed in the last part of the small intestine, but for this to happen it needs to be combined with a protein called intrinsic factor, which is secreted by the lining of the stomach.
Patients who have undergone major surgery to remove the stomach or some of the small intestine are, therefore, at risk of developing pernicious anaemia.
Inflammatory bowel disease can also lead to poor absorption of vitamin B12.
Inflammatory bowel disease or major bowel surgery can lead to poor absorption of vitamin B12
But in most people the condition is an autoimmune disease. In these patients — for reasons we don’t fully understand — the body creates antibodies that damage the cells lining the stomach so it can no longer generate intrinsic factor.
Low levels of B12 can also be down to diet or even — in rare cases — due to infection, with the giant fish tapeworm diphyllobothrium latum, which gobbles up the vitamin, depriving its host.
The body does have stores of vitamin B12 in the liver, so it can take up to three years for symptoms to develop.
Vitamin B12 is vital for the formation of blood cells in the bone marrow, which is why a lack of it causes a form of anaemia, leading to symptoms such as fatigue, pallor, palpitations, breathlessness and headache.
Vitamin B12 is vital for the formation of blood cells in the bone marrow, which is why a lack of it causes a form of anaemia, with symptoms such as fatigue, pallor and headache
It’s also critical for the normal function of the brain and nerves, and so a deficiency can cause problems with memory and mood as well as tingling and numbness.
Some patients experience mood changes months before the onset of anaemia. This is why patients with psychiatric illness and dementia are routinely tested for vitamin B12 levels in the bloodstream.
Before injections of the vitamin became available the condition could even prove fatal.
Your regular injections of vitamin B12 (in the form of cyanocobalamin or hydroxocobalamin) will have topped up your liver stores of the vitamin over time.
But rather than watch and wait and retest your blood level periodically, it would be simpler and less expensive to continue to give the injections at least twice a year.
Regular injections of vitamin B12 (in the form of cyanocobalamin or hydroxocobalamin) will have topped up your liver's stores of the vitamin over time
It remains unclear to me why your doctor decided to review your diagnosis, unless there is an extra factor in your history that I don’t know about — perhaps you used to have a vegan diet but now eat animal products again, for example.
But if that were the case you would not have been given a formal diagnosis of pernicious anaemia.
However if your diagnosis was based upon a low blood B12 level and you were also found to have intrinsic factor antibodies, possibly along with anti-parietal cell antibodies (antibodies to the cells lining your stomach), then there can be no doubt that you do need life-long supplementation injections of vitamin B12.
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