First of all, as parents you must accept that what your kid has a problem with is not life-threatening, is not evidence of a severe psychological order or that your child was abused. It is not a deadly disease and it's not the end of the world: It is just HAIR. (Or skin as the case may be.) The more YOU panic, the more your child will. The only way to conquer trich and skin picking is to do so from a calm place, a place of acceptance, a place where one can tolerate the fact that recovery is two steps forward, one step back. And the only way these things can be conquered is when the person who is experiencing them are ready.
Yes I KNOW you are worried about your child at school, your child at prom, your child's self-esteem, your child loving him or herself. But if your child isn't ready, if the hair pulling is not yet bothering your child at age 8, then dragging him or her to doctor after doctor, and therapist after therapist, and putting them on medication, will only do one thing: Convince your child she is defective. And what you need to do is just the opposite.
I've met MANY 8-year-old hair pullers. When I ask them if they want to stop, at first they say yes. When I ask them if they are bothered by the pulling, they ultimately admit that what they are bothered by is that their mom is so upset. I cannot tell you how many times I've heard this. If that is where your child is, then sure, they will benefit from knowing about trich, from attending a Trichotillomania Learning Center (TLC) conference with you (trich.org), which is great for the whole family. I will often meet with a child that age once and explain to them what trich is and that it's a disorder, that other kids have it, and that it's not their fault. I also tell them that I used to pull my hair out, too, and that if they ever want help with this, to ask their mom and I know she will bring them back. And in many if not all of those cases, the child will ask their parents to bring them back to see me when they turn about 11 or 12.
Then there is the child or teen who is upset about having trich. Please hear me on this. If you go into panic mode here that is how you are teaching your child to deal with having trich. And that most assuredly will fail. What you MUST do is console your child. Say, I know it is upsetting honey, and it's certainly not fair, but we will get through this together. I will take you to see someone who knows about trich and they will be able to help you. I know you're upset and scared honey, but, you know what? I believe in you and I love you. I know you are upset about your hair/skin, but I want you to know you are a wonderful, beautiful, lovable person. You don't have to stop pulling for that to be true. Trich is a disorder that they are learning more and more about. We will find someone who will help. And in the meantime, don't blame yourself or get mad at yourself for having this disorder. It is not your fault. I want you to know you a extraordinary person and this does not change that fact one bit.
In terms of exactly HOW your child can stop, the answer is, you cannot help them stop. They MUST see a professional. You as a parent, even if you ARE a psychotherapist, cannot help your own child stop pulling, although you can help your child have the best chance of recovering by accepting them just as they are and loving them no matter what. If you do nothing else, please stop telling your child things like, "Stop pulling, honey." "Get your hands out of your hair," or "Stop touching your skin." Do not ask them how the recovery from pulling is going every day. Do not examine their head to see how much they've pulled. Do not say, you had better stop or you will be bald, if you don't stop you won't have any lashes or brows and those may not grow back. All these messages will create anxiety and fear in your child and make it that much harder to stop. And that anxiety and fear is YOURS, not your child's.
You must be the one who is calm and reassuring. You are the adult. If you see your child pulling, feel free to say, Honey, could you come here for a moment? Or, Take a look at this! Or say something that allows them to stop without calling attention to it. If they are sitting somewhere, go over to them and hug them. The thing you need to do is to help your child learn to self-soothe. If their anxiety is met with your anxiety, they will have no way to deal with things that scare them or upset them or make them feel stressed. And we all know there are plenty of those. At present they are using hair pulling to calm themselves down. So getting upset with them and constantly pointing out what they are doing and making them feel just the opposite of soothed will only cause them to pull more. Telling them, Sweetie, I know it's upsetting but you will get through this. This disorder is challenging and I know you feel sad and upset, but we will get help and do everything we can to help. You are not "ugly" and you are not "weird." You are my beautiful daughter and trich can't change that! A lot of people have this disorder. I know it still hurts and is upsetting, but I want you to know how much I love you and believe in you. This will be OK. We will find out all we can and we will face this together!
This kind of support, where you reassure your child, you tell your child that it's OK to hurt, but also to know that you will get through this, to reassure your child that he/she is still beautiful and lovable, that he/she is still worthy, that these confusing things happen and that they can get through them, this will help your child learn to self-soothe. And learning to self soothe is pretty much the only "substitute" for hair pulling.
One other thing about examining their head or eyes, knocking on the bathroom door, telling them to stop touching their hair: It is their body, not yours. They have the disorder, not you, and they have to become ready to deal with it, rather than work on recovery because you want them to. It's quite important for children with trich to have those boundaries respected, because often they feel so exposed to the world as it is. Children, all children, need dignity and respect. But when you have a disorder that is exposed to the world, even more so. Once you let your child know what trich is, maybe meet with a therapist to have them explain it further and allow your child to ask any questions, then allow your child to decide when she is ready to address the trich. The more you allow your child space to decide and respect their decision, the quicker that time will likely be. And yes I know it's hard to see your child hurting. But pain is a part of life, even for a child. The more you comfort him, the more you let him know that it's OK to be sad or upset and reassure him that he will get through this, the more equipped to deal with emotional pain he will be.
Most importantly, don't forget all the other things about your child (or your other children). Don't make trich the sole topic of conversation with your child. Ask about school work, friends, dance, track or whatever else your child is doing. Chances are most 8-yr-olds won't be able to address this themselves at that age. You can consult with a therapist, you can help them understand what is happening to them, you can find a way to cover up their hair or brows in some way. But you cannot force them to stop or motivate them to stop. Those of us who have trich do not need additional motivation. We want to stop and you can't make us want it more. Or if we are 8, we may actually not care what we look like that much. So it's really you that is upset, not us.
The reason I say that parents need help too is because most parents are not able to be calm and relaxed and supportive when their child says, I'm so upset about my hair. Or when their younger child has some missing lashes or patches of hair. Of course it's important to seek help, to find a therapist, to become a member of TLC and receive all their information. But what is also important is that you not panic and that you not hold this as if it's the end of the world. Your child will learn how to see him or herself from you. The more you panic and the more you behave as if this is a disaster, the more pressured and stressed your child will feel. The main source of stress from most kids I see is their parents' relentless worry about the trich. The child ends up having to calm the parents down and ignore their own feelings. This is SO common I cannot tell you. And it becomes a huge block to recovery.
So if you cannot calm down, that's human and understandable. But seek help rather than sharing your fear with your child via constant advice and questions. Find a therapist you can vent to, someone who knows not to panic, who can hear your panic and who can help you get through your own fears. If you don't, you will pass your fear on to your child and your child will become the caretaker. The more you can remain centered, the more you can comfort your child, reassure your child, let your child know that he or she is not defined by trich, that he or she is lovable just as she is right now.