Ciliary madarosis (CM) is a form of alopecia commonly associated with more extensive hair loss, which has cosmetic and psychological implications. Among the pediatric population, there are 4 important etiologic considerations: alopecia areata (AA), tinea capitis, trichotillomani (TTM), and telogen effluvium (TE). Recognizing the subtle differences that characterize there forms of alopecia allows for prompt and appropriate treatment. We present the case of a 9-year-old white girl with bilateral CM and no further evidence of alopecia elsewhere on her body. She was diagnosed with TTM and successfully treated with bimatoprost opthalmic solution 0.03% (Latisse, Allergan, Inc). We also review the other common conditions that rseult in pediatric alopecia by identifying and comparing clinical, diagnostic, and therapeutic approaches unique to each condition.