Hair Pulling 3

Four-year-old girl with CdLS has been doing very well. Her play skills have been improving over the years. She can match objects, do a simple single puzzle piece, and play with a doll. She now understands the phrases, “come here,” “we are going in the car,” “we are going to school,” “would you like a drink/food?” She knows and reacts to “No.” She loves praise and all forms of support and fun. She always wants attention. Suddenly, she has started to pull her hair out. Within one hour, she had pulled half of her head full of long hair out. She was due two days later to have two teeth out and a biopsy on her esophagus. We had one tooth pulled out a day earlier, followed by pain management, Paracetamal and Dihydro codeine in large doses. This seemed to have no effect on the pain, but did send her “loopy” and very strange in her behavior. She has been tugging and pulling her hair out since, even with vigorous distraction, hats, and her hair “oiled” up. Last week I decided to cut the rest of her hair off. Since then, she has started to cut at herself with her nails, which I have cut down as low as possible. She attacks her arms, legs, face, neck, and tummy. I have put socks on her hands to stop her but she does pinch through this. Her body is now full of many little cuts and is a bleeding mass. How can I break this cycle of self-destruction?

I was quite taken aback by the relative severity of your daughter’s self-injury and hair pulling, but the clue may lie in the hair pulling part. This phenomenon, known as trichotillomania, is associated with anxiety and obsessive-compulsive disorders and has responded to medication. I suggest you look at the various physical sources of pain and anxious feelings such as GI upset, itching, arthritic pain and joint abnormalities, but if there is no discernible cause, consider Paroxetine. I must admit; however, that in a four-year-old, this would be controversial and extremely “off label” for this medicine. My pediatrician friends cannot begin to suggest a dose for such a small child– perhaps 2.5 to 5 milligrams per day would be relatively safe.

DS/TK 7-13-10

We have heard of success in similar situations by the use of special gloves that do not allow the child to be able to get at the nails. You may get some further information through the on-line parent support group.

TK 7-13-10

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