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Is my toddler's flaky scalp dandruff or something else?

The question: My three-year-old is starting to get flaky skin on her scalp. Is this run-of-the-mill dandruff or could it be caused by something else? Is over-the-counter medicated shampoo recommended for a child that young?

The answer: In my experience, dandruff is generally uncommon among young children. So you would want to keep an open mind about other possibilities.

Children with sensitive skin or allergic tendencies may have eczema of their scalp. Other common pediatric conditions such as seborrheic dermatitis (cradle cap) and psoriasis can also cause dry, flaky skin on the scalp. More rarely, a fungal infection of the skin can cause similar symptoms, sometimes with swelling of the scalp and hair loss.

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Children with lice often have itchy scalps, and this constant scratching could lead to flakes of skin in the hair. Children with lice will also have small "nits" attached to hairs. These nits, which are actually lice eggs, are small and white, and are found attached firmly to the base of the hair near the scalp. From a distance, they could appear a little like dandruff, although are usually easily distinguished from upon closer inspection.

If you are convinced that this is dandruff, then a trial of an over-the-counter medicated shampoo is probably safe and may even help if your child's symptoms are caused by cradle cap. I wouldn't hesitate, however, to get your child's doctor's opinion, especially if the symptoms are severe or don't improve with the shampoo.

Send pediatrician Michael Dickinson your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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