Joanna Fortune: My granddaughter doesn't want anyone to know about her alopecia 

"Sometimes, when a child says not to tell anyone, they want to control how often and with whom they need to talk about something they find challenging."

My daughter’s children are between four and nine years old. She had treatment for cancer last year and is doing well now. One of the girls has since developed alopecia on an area of her scalp. She is seeing her GP and is waiting for a dermatology consultation. My granddaughter doesn’t want anyone, including me, to know about it. How do we support her in managing her condition?

What a lot of stress you and your family have been through this last year. I am happy to read that your daughter is recovering well from her illness, but I am also aware that the stress and worry caused by a loved one being ill can linger long into recovery. Go gentle with yourself and each other while you all recover from a worrisome experience.

Your granddaughter’s alopecia may have been triggered by anxiety around her mum being sick. She is very young and will lack the emotional fluency to adequately process and express how she felt about her mother’s illness.

Alopecia is an autoimmune condition and can also be caused by vitamin or mineral deficiencies. All the right steps are being taken - consulting with the GP and getting a referral to a consultant dermatologist.

It sounds as though your granddaughter is, understandably, self-conscious about her hair loss. Your longer letter details how she longs to be just like her friends. This response is very normal. She is at an age when acceptance and fitting in within her peer group are paramount.

Sometimes, when a child says not to tell anyone, they want to control how often and with whom they need to talk about something they find challenging. It is not a rejection of you or anyone else she doesn’t want to know about her condition.

An essential part of her treatment will be helping her find ways to express and process her feelings about her mother’s past illness and her own hair loss. While waiting for the dermatology appointment, I suggest also seeking a referral to a play therapist. Play therapy can be very effective for young children to work symbolically through difficult experiences or anxiety in a way that enables them to release tension and make meaning of complex thoughts and feelings. Play is the language of children, and play-based therapy is a specialised intervention to support them to ‘say’ what they find difficult to articulate in words alone. (Check out www.iaptp.ie for a list of accredited play therapists.)

Another resource you or your daughter might find helpful is to follow @claire_balding on Instagram. Claire is a certified trichologist (a hair/scalp specialist) with personal and professional expertise in hair loss.

While waiting for the specialist appointments, I suggest increasing your granddaughter’s fun and free-play time over the summer. I would offer lots of sensory-based (messy/tactile) play and as much time moving and playing outdoors as possible.

Regardless of what triggered her alopecia, play will help to lower stress levels. Also, when our brain is overstimulated by stress or anxiety, getting outdoors and increasing movement can be an effective way to reset it. Time spent playing together as a family will benefit everyone, and after such a difficult year, you certainly deserve to have fun together now.

If you have a question for child psychotherapist Dr Joanna Fortune, please send it to [e-mail]