What causes grey hair in children?

Causes of Grey Hair in Children

Grey hair in children is primarily caused by genetic factors, but nutritional deficiencies—particularly vitamin B12, vitamin D3, serum ferritin (iron stores), and calcium—are significant modifiable contributors that should be systematically evaluated. 1, 2, 3

Primary Etiological Categories

Genetic and Hereditary Causes

• Autosomal dominant inheritance is the most common cause of premature graying, typically presenting without underlying pathology 1
• Familial predisposition syndromes include specific genetic mutations that manifest with premature graying as part of their phenotype 4:
  • TERT/TERC mutations cause premature graying alongside nail/skin changes, sensorineural deafness, and signs of early aging 4
  • These patients have increased risk for head and neck cancers, anogenital cancers, and skin cancer 4

Nutritional Deficiencies (Most Clinically Actionable)

• Vitamin B12 deficiency shows significantly lower serum levels in children with premature graying compared to controls (P < 0.001), and can present with anemia, hyperpigmented skin, paresthesia, recurrent aphthous ulcers, and epistaxis 2, 3, 5
• Vitamin D3 deficiency (<20 ng/mL) is significantly more prevalent in cases versus controls, with lower levels correlating with premature graying 1, 2
• Serum ferritin deficiency demonstrates statistically significant lower levels in affected children (P < 0.001) 1, 2, 3
• Serum calcium deficiency shows significantly lower levels in children with premature graying 1, 2
• Low HDL-cholesterol is associated with premature graying (P < 0.001) 2, 3

Autoimmune and Systemic Conditions

• Autoimmune disorders are associated with premature graying, though the exact mechanism remains unclear 1
• Thyroid dysfunction should be considered, as thyroid disease associates with hair pigmentation changes 4
• Atopic diathesis shows significantly higher proportion in cases versus controls 2

Environmental and Lifestyle Factors

• Oxidative stress from smoking, poor diet, and sedentary lifestyle contributes to premature graying 2, 6
• Sedentary lifestyle and irregular eating habits are significantly associated with premature graying 2, 3
• Lack of hair oiling (conversely, regular hair oiling appears protective against premature graying) 2

Diagnostic Algorithm for Children with Grey Hair

Step 1: Clinical History

• Family history of premature graying (autosomal dominant pattern) 1, 2
• Associated symptoms suggesting systemic disease:
  • Anemia symptoms (fatigue, pallor) 5
  • Neurological symptoms (paresthesia) suggesting B12 deficiency 5
  • Skin changes (hyperpigmentation, nail dystrophy) 4, 5
  • Recurrent infections or aphthous ulcers 5
  • Hearing loss or skeletal abnormalities (genetic syndromes) 4
• Lifestyle factors: smoking exposure, diet quality, physical activity level 2, 6

Step 2: Physical Examination

• Extent and pattern of graying (diffuse vs. patchy) 6
• Associated findings:
  • Skin hyperpigmentation or nail changes 4, 5
  • Signs of anemia (pallor, tachycardia) 5
  • Dysmorphic features suggesting genetic syndromes 4
  • Thyroid enlargement 4

Step 3: Laboratory Evaluation (Targeted Based on Clinical Suspicion)

Essential first-line tests for all children with premature graying:

• Serum ferritin (optimal ≥60 ng/mL for hair health) 1, 2, 3
• Vitamin B12 (deficiency strongly associated with premature graying) 2, 3, 5
• Vitamin D3 (check for levels <20 ng/mL) 1, 2
• Serum calcium 1, 2

Additional tests if clinically indicated:

• Thyroid function (TSH, free T4) if thyroid disease suspected 4
• Complete blood count if anemia suspected 5
• Lipid profile (HDL-cholesterol, LDL-cholesterol) 2, 3
• Hemoglobin and total iron binding capacity if iron deficiency anemia suspected 1

Step 4: Genetic Evaluation (If Indicated)

• Consider genetic testing for TERT/TERC mutations if premature graying occurs with 4:
  • Nail and skin changes
  • Sensorineural deafness
  • Pulmonary fibrosis or cirrhosis
  • Family history of early-onset cancers

Common Pitfalls to Avoid

• Do not dismiss premature graying as purely cosmetic without evaluating for nutritional deficiencies, as these are highly treatable causes 1, 2, 3
• Do not overlook vitamin B12 deficiency, which can cause irreversible neurological damage if left untreated despite dramatic therapeutic response when caught early 5
• Do not fail to check vitamin D3 levels, as 70% of affected patients may be deficient versus only 25% of controls 1
• Do not ignore associated systemic symptoms (anemia, paresthesia, skin changes) that may indicate serious underlying conditions requiring urgent intervention 4, 5
• Do not order extensive genetic panels unless clinical features suggest specific hereditary syndromes with premature graying as part of a broader phenotype 4

Treatment Approach

Supplement identified nutritional deficiencies according to standard pediatric guidelines:

• Vitamin B12 supplementation shows dramatic therapeutic response in deficient patients 5
• Vitamin D3 supplementation for levels <20 ng/mL, following general international recommendations for children 1
• Iron supplementation when serum ferritin is low 1, 3
• Calcium supplementation if deficient 1

Address modifiable lifestyle factors:

• Encourage regular physical activity and balanced nutrition 2, 3
• Eliminate smoking exposure 2, 6
• Consider regular hair oiling as potentially protective 2