What is pica?

Pica is a compulsive eating disorder that affects 10% to 30% of young children, ages 1 to 2. It is the act of eating nonfood items. Dirt, clay, and flaking paint are the most common.

Less common items include glue, hair, cigarette ashes, and feces. It is most common in children and adults with intellectual and developmental disabilities, such as autism. On rare occasions, pregnant women crave strange, nonfood items. For these women, pica often involves eating dirt and may be related to an iron and zinc deficiency.

It is more common in children who have developmental delays. Tasting and putting nonfood items into the mouth is normal for infants and toddlers. However, as the child gets older, it is not normal and may be diagnosed as pica if this behavior continues for longer than 1 month or is excessive. Pica generally goes away with proper treatment or as the child gets older.

Symptoms of pica

The main symptom of pica is the repeated eating of nonfood items. Some common items include dirt, sand, animal feces, paper, paint chips, chalk, and soap. Other symptoms may appear depending on what is eaten.

Pica symptoms are related to the nonfood item he or she has eaten. They include:

• Stomach upset
• Stomach pain
• Blood in the stool (which may be a sign of an ulcer that developed from eating nonfood items)
• Bowel problems (such as constipation or diarrhea)

• Nutrient deficiency, such as low iron in the blood.
• Problems in the nervous system or intestinal tract, such as intestinal blockage.
• Poisoning if the substance is toxic, such as paint chips that contain lead.
• Infection if the substance contains animal waste or contaminated soil.

These symptoms are the result of the toxic, poisonous, and bacterial content of the nonfood items. Repeatedly eating nonfood items over a period of time can cause lead poisoning, an intestinal blockage or tear (from eating hard objects, such as rocks), injuries to teeth, and infections (from organisms and parasites that get inside the body and cause disease).

What are the causes?

The exact cause of pica is not known. The craving to eat the nonfood item may be due to the child not getting enough nutrients through his or her diet (dietary deficiency), such as an iron deficiency. It is not clear if the deficiency is the cause of pica or a result of pica.

What increases the risk?

A child may have a higher risk of developing pica if he or she:

• Has a developmental delay.
• Has behavioral or emotional problems, or a mental health disorder.
• Comes from a disorganized family or has been abused or neglected.
• Does not eat food by mouth.

How is pica diagnosed?

Many typical children chew on things such as their nails and ice, or mouth their toys and hair. A person diagnosed with pica repeatedly eats nonfood items, even if they make him or her sick.

This condition is diagnosed based on your child’s symptoms and his or her medical history. If your child has pica or is suspected of having pica, certain tests may be done, including:

• Blood tests.
• Stool tests.
• Imaging studies, such as X-rays.

• Your doctor will look at your child’s physical symptoms (stomach upset, bowel problems).
• If your child is in a high-risk group for pica (intellectual and developmental disabilities), your doctor may ask if you have seen your child eating nonfood items and for how long.
• If the behavior has occurred for a month or more, your doctor may diagnose it as pica.
• Your doctor may order a blood test to check your child’s iron and zinc levels. Not having enough of these vitamins is considered a trigger for eating dirt and clay in some cases.

Pica treatment

Treatment will address several areas. Your doctor will address your child’s illness from having eaten nonfood items. For example, your doctor will treat your child’s constipation, diarrhea, ulcer, intestinal tear, infection, or any combination of illnesses.

If your doctor finds your child doesn’t have enough iron or zinc, he or she will address that with a vitamin supplement and dietary recommendations.

Treatment of pica involves treating any symptoms and underlying conditions. It also involves taking steps to stop the child from eating the nonfood item. Your child’s health care providers will work with you to determine a plan for treatment. This plan may include:

• Nutrient supplements to treat dietary deficiencies, such as iron deficiency.
• Behavioral therapy.
• Medicines.
• Monitoring. You and your child’s caregivers will need to monitor and control your child’s eating habits.
• Treating the side effects of pica, such as:
  • Lead poisoning from eating lead-based paint. Lead poisoning can lead to learning disabilities or even brain damage.
  • Intestinal issues, such as constipation or obstruction.

Another focus of treatment will address the underlying cause of your child’s pica diagnosis. Your doctor will discuss your child’s home environment, educate you as a parent, and refer your child to a behavioral or mental health specialist.

Can pica be prevented or avoided?

Pica cannot be prevented. Proper nutrition may help some children. If your child has been diagnosed with pica, you can reduce his or her risk of eating nonfood items by keeping those items out of reach in your home. Monitor your child’s outside play.

Living with pica

Most children outgrow pica as they get older. However, high-risk populations, such as children and adults with intellectual or developmental disabilities, may need continued monitoring of their behavior and environment.

Questions to ask your doctor

• Can behavior therapy retrain my child from eating nonfood items?
• What signs should I look for in cases of lead poisoning, ulcers, infections, or intestinal tears?

Follow these instructions at home:

• Keep any nonfood substances that your child eats away from him or her.
• Watch your child closely and take away the nonfood item right away.
• Create and follow a plan for you and your child’s caregivers to correct your child’s behavior.
• Use child-safety locks and high shelving to keep dangerous substances, household chemicals, and medicines out of reach.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Have your child drink enough fluid to keep his or her urine pale yellow.
• Keep all follow-up visits, such as therapy visits, as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Is constipated.
• Has eaten paint chips.
• Has a fever.
• Has abdominal pain.
• Has a decreased appetite.
• Has diarrhea.
• Looks pale.
• Tires easily or gets dizzy.

Get help right away if your child:

• Has repeated vomiting, especially if the vomit is greenish in color or contains blood.
• Has a severe headache.
• Has severe abdominal pain.
• Becomes uncoordinated or confused.
• Is unusually drowsy.
• Has a seizure.
• Has eaten or swallowed a possible poison or a sharp object.

If you think your child was exposed to a poison, call the local poison control center right away. Call 1-800-222-1222 (in the U.S.) to reach the poison control center for your area.

Summary

• Pica is an abnormal eating of nonfood items.
• Children with developmental delays, nutrient deficiencies, or emotional and behavioral problems are at a higher risk of developing pica.
• Treatment for pica includes monitoring your child’s eating, removing harmful nonfood items from the child’s reach, and behavioral therapy. Some children may require nutrition supplements.

Sources

Autism Speaks, Pica