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Home › Expert Q&A › Misc › My 20-month-old son has always twirled his hair or mine for comfort when he was tired. Should I be concerned?

Expert Q&A

 

By Keath Castelloe Low
child and adolescent psychologist

My 20-month-old son has always twirled his hair or mine for comfort when he was tired. Lately, however, whenever he is upset or frustrated, he reaches for his hair and has even started pulling it out a few strands at a time. His pediatrician called it trichotillomania, and suggested he wear a hat or get a buzz cut. Are there other behavioral modification techniques we can try?

Trichotillomania is a psychological condition characterized by repeated, uncontrollable urges to pull out one's own hair. It is sometimes referred to as an impulse control disorder. A person with trichotillomania feels an increasing sense of tension before pulling out their hair or when attempting to resist the pull and a sense of relief afterwards. The behavior causes great distress in a person's life.

Many experts believe that hair twirling or pulling that occurs before the age of 5 is more indicative of a habit than a disorder. For these children hair twirling or pulling is a tactile stimulation that is self soothing.

It is not unusual for infants to pull on their mother's hair while being held or nursed. Toddlers may move up to pulling on their own hair as their hair grows longer. The pulling becomes a habit and may increase during times of anxiety and stress.

Talk to your toddler and let him know that you do not want him to hurt himself by pulling out his hair. Be reassuring and supportive. A strong or punitive reaction may increase his feelings of anxiety. If he receives too much attention it may also reinforce his negative behavior. Be matter-of-fact, but loving in your approach.

When your child begins to pull his hair, gently move his hands and distract him with another item like a Koosh ball. These balls are fun to hold and squeeze and they provide tactile stimulation similar to hair. You can also provide him with other fun, touchable items – a bowl of satin ribbons, rolls of fuzzy yarn, a soft feathery boa.

Find a box of happy, colorful bandages with characters your child likes and make a game out of putting them on the tips of his fingers. This will make it harder for him to pull his hair out. If he protests and does not enjoy this idea, then do not persist.

Teach your child simple ways to relax such as taking a deep breath. It may be hard for a 20-month-old to understand, but give it a try. You can also teach him to squeeze and open his fists. Check to make sure his environment feels safe and is as stress free as possible. Lots of changes and unpredictability can increase feelings of anxiety for a young child.

Review your toddler's napping and night time sleep schedule. Make sure he is getting enough sleep, between 10 to 13 hours in a 24-hour period. A child who is overtired tends to frustrate and tantrum easily resulting in the hair pulling behaviors you hope to eliminate.

If all else fails, a short haircut may also help.

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