“People who meet my child for the first time don’t know what to think.” Sound familiar? Even though alopecia areata in children is common, many people don’t know what it is. Anyone can develop alopecia areata at any age, but it often first appears during childhood. Children who have the disease go through different stages of awareness and acceptance as they grow and change. Children and Alopecia Areata Pediatric alopecia areata affects about 1 in every 1,000 children and teens. Compare this with 1 in 400 who develop type 1 diabetes, 1 in 12 who have asthma, and 1 in 345 who have cerebral palsy. A recent study suggests that: More girls develop alopecia areata than boys. The disease is more common in teens (over age 12) than children (12 and under). More children of Asian or Hispanic descent have alopecia areata than other races or ethnicities. In addition, children who develop alopecia areata at younger ages (5 years old or earlier) may be more likely to progress to more severe forms of alopecia areata (alopecia totalis or universalis). Social Impact of Alopecia Areata Alopecia areata in children 5 years and younger Preschool-age children are busy exploring the world, learning new skills, and becoming independent. They don’t usually pay much attention to their own physical appearance, or the differences they may have from others their age. As a result, preschoolers with alopecia areata don’t usually have as much of an emotional impact from their hair loss. They may see it as interesting, but not much more. And their friends at this age aren’t likely to notice either. Alopecia areata in children 6 and older By the time children reach their sixth birthday, they’ve begun to interact with more people of all ages. They’ve gained enough experience to start noticing differences between themselves and others. Between the ages of 6 and 12, children also become more aware of how others think and feel. They may focus on how others see them, or how their condition may make them seem different from their friends. This new stage can make it hard for older children to accept their alopecia areata, even if they weren’t bothered before. Their self-confidence may drop both at school and socially. The authors of a small study published in 2017 found the following: 48% of teens are embarrassed about their hair loss. 7% said that their hair loss affected their friendships. 59% said that they have been stared at or people have talked about them. 52% said that their hair loss made them limit their activities. Unfortunately, children with alopecia areata can be bullying victims. According to the same study, bullying is more common with older children: 13% of children aged 12 to 14 years and 40% of teens from 15 to 19 have been bullied because of their hair loss. The study also reported that bullying occurred more often in children and teens with milder disease than in those with more severe forms (alopecia totalis or universalis). Bullying can be subtle or glaring. It can be verbal (taunting, threats, etc.), social (exclusion, spreading rumors, etc.), physical (hitting, tripping, fighting, and more), or cyberbullying. NAAF is on the forefront of bullying prevention efforts. This article is well worth reading as 30% of interviewed students said they were bullied because of the way they looked. If you suspect your child is being bullied, there are ways you can help. Work with your child to understand and identify bullying behaviors. Keep open communication with your child. Check in with them often and listen to them. Encourage your child to participate in activities they enjoy. This can help build friendships and foster confidence. Model how to treat others with kindness and respect. Remember that your child wants you to help them with ideas on how to manage a bullying situation. Actively talk with school and youth group leaders about alopecia areata so that they may intervene on behalf of your child. For more information on preventing, responding to or getting help for your child if they are experiencing bullying, go to StopBullying.gov. For information and support on cyberbullying visit Alarms.org’s Guide to Cyberbullying. Alarms.org is the official site of the National Council for Home Safety and Security. Emotional Wellness in Children Like adults, children can also develop anger, depression, or anxiety as a result of alopecia areata. They may feel overprotected or become socially isolated. These feelings must be addressed to try to keep them from getting worse. But unlike most adults, children might not be able to identify or express their feelings in a way that adults can understand, so you need to look for clues. According to the Centers for Disease Control and Prevention (CDC) symptoms of depression in children include: Feeling sad, hopeless, or irritable a lot of the time Not wanting to do or enjoy doing fun things Changes in eating patterns – eating a lot more or a lot less than usual Changes in sleep patterns – sleeping a lot more or a lot less than normal Changes in energy – being tired and sluggish or tense and restless a lot of the time Having a hard time paying attention Feeling worthless, useless, or guilty Self-injury and self-destructive behavior And symptoms of anxiety in children include: Excessive fear or worry Irrational anger Trouble sleeping Physical symptoms such as fatigue, headaches and stomach aches If you think your child may be experiencing one or more of these symptoms, make an appointment with your healthcare professional. It’s important to check with your doctor to determine if your child is experiencing depression or anxiety, or another related issue. Emotional wellness is just as important as physical wellness and contributes to success in school, work, and society in general. Parenting a child with alopecia areata – what can you do to help? As a parent or guardian, you can help your child educate their classmates and teachers. You can also provide them with the opportunity to address their feelings with a support group or a professional counselor. This may help them feel more confident about themselves as they participate in activities they enjoy and succeed in school. Some parents of children with alopecia areata say that it can be just as traumatic for them as it is for their children. Thankfully, there are many positive and productive things that you can do to cope with your child’s alopecia areata. You can: Join a support group Get involved at your child’s school to help teach their friends, teachers, and others about alopecia areata Attend conferences where you can connect with others who have alopecia areata and their families There are also ways you can try to help your child: Try not to be overprotective or overly permissive with your child, just because they have alopecia areata. Speak directly, frankly, and honestly to your child about the disease Encourage your child to speak about their feelings about the hair loss Providing a supportive experience at school Even though alopecia areata is common, many people don’t know what it is. Even if they do know what it is, they may not realize the emotional impact the disease can have. That’s why it’s important to educate and inform people at your child’s school about alopecia areata. Doing so can help your child – and any other with the disease – have a more positive and productive experience in the classroom. The Alopecia Areata School Guide provides lesson plans, classroom strategies, tips for parents and teachers, facts about bullying, ideas for awareness projects, recommended readings, and so much more. Treatment for Children with Alopecia Areata How a child feels about having alopecia areata usually depends on their age. Younger children may not notice or feel any impact because of their hair loss. They may not want to treat or even cover their scalp. Older children and adolescents might have more concerns, though, as they navigate interactions with people at school and social activities. When your child is diagnosed with alopecia areata, you and the dermatologist will discuss treatment options. When making a decision, take into account how your child feels about the hair loss and is coping with the disease. There are no FDA-approved treatments yet for children with alopecia areata. There are, however, therapies that many dermatologists use with children that were approved for other diseases. Many treatments used in adults are also used off-label in children and adolescents. Learn more about treatments on this page. There is real hope that better treatments are coming. One drug, Olumiant (baricitinib), a JAK inhibitor, was approved in 2022 to treat adults with alopecia areata. There are more that will likely be approved soon. Researchers are currently looking to see how effective and safe these drugs are for children and they hope to have FDA approval soon. Additional Resources NAAF Youth Mentor Program The NAAF Youth Mentor Program provides support and guidance to children to help them deal with the day-to-day challenges of living with alopecia areata. Learn more about the program here. Bullying Webinar Watch NAAF’s webinar from August 2022: Identifying Bulling And Standing Up To It Safely
