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Pica In Children: Causes, Symptoms And Treatment

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Children are naturally curious. Up to a particular developmental stage, they tend to put almost any object in their mouths as they try to understand the world. Once that stage passes, kids know what to put in their mouths and what not to.

But sometimes, a child may again pick up the odd habit of eating dirt, paper, sand, paint, etc. And this can be a sign of pica in children.

In this post, MomJunction tells you why some children choose to eat non-food substances, how it can harm them, and what is to be done.

What is Pica?

Pica is an eating disorder in which children develop cravings for non-food items for more than a month. The word ‘pica’ comes from the Latin word magpie, a bird with an indiscriminate appetite. It is also known as compulsive eating disorder. 

Pica disorder can surface at any time during childhood, adolescence, or adulthood, especially in individuals with developmental disabilities. Pica could be more prominent people of lower socio-economic groups with probable attribution to poor child-rearing practices such as child abuse and neglect (1) (2).

Children with pica eat a variety of substances such as:

  • Clay
  • Cloth
  • Sand
  • Paint
  • Chalk
  • Glue
  • Soap
  • Ice
  • Hair
  • Coffee grounds
  • Cigarette ashes
  • Paper
  • Metal
  • Talcum powder
  • Starch
  • Pebbles
  • Animal feces
  • Rubber bands
  • Shampoo

Causes of Pica in children

The exact cause of pica is not known. However, here are some of the most common triggers (2) (3) (4).

  1. Gastrointestinal distress: Some children with GI distress might find it soothing to eat non-food items, especially earth.
  1. Nutritional deficiency: Iron deficiency, zinc, calcium or some other trace elements deficiency may trigger specific cravings.
  1. Obsessive-compulsive spectrum disorders: The anxiety arising out of these disorders might make the individual eat non-food items to get some relief. Any attempts to forcefully stop them from eating might increase their anxiety and distress.
  1. Malnutrition: Deficiency in the intake of nutritious food might trigger cravings for soil or clay. Though soil/ clay does not have the nutrients to meet the deficiencies, it binds to iron in the gastrointestinal tract, thus soothing the cravings.
  1. Oral fixations: Some children have an oral fixation, an obsessive urge to put things in their mouth. This is common in very young kids.
  1. Mental and developmental growth delays: Children, especially those with autism or other developmental conditions, might eat unhygienic or non-food materials like dirt or paper due to their inability to differentiate (5).
  1. Lack of proper appetite stimulation: Some picky eaters may suppress their hunger by eating non-food objects.
  1. Poor parental attention: Parental neglect is a major cause seen mostly in people living in poverty where they might fail to supervise their child’s diet.

All the triggers and causes shared above are etiological theories prevalent since ages but no one theory could be attributed to the cause of pica and its various subtypes. If your child is eating non-food items almost every day, then observe them as this could be the symptom of pica. Consult a pediatrician as you yourself may not identify the symptoms well.

Children below two years of age usually explore many things through mouth, it is not  pica even if they are ingesting non-food items.

Pica Signs in Kids

These are some signs which could help you identify pica (6):

  • The child has been eating non-food substances for more than a month despite efforts to stop it.
  • Their eating patterns and cravings are not on par with their age or behavior.
  • Your child’s eating habits are not a part of some ethnic or cultural food traditions. For example, in parts of Africa and some rural areas of the US, eating clay is believed to cure gastrointestinal problems (7).
  • If your child is recurrently consuming high amounts of soil that can be a soil-pica syndrome or geophagia. This could be due to serious iron-deficiency.

[Read: Anorexia In Children]

Depending on the substances the child is eating, they may have a few other symptoms such as (8):

  • Stomach pain, nausea and bloating due to intestinal or stomach blockage.
  • Poor nutrition and fatigue.
  • Behavior problems
  • Lead poisoning

Pica is not a standalone condition as certain deficiencies lead to this problem, and this problem leads to a few more mild or severe complications. In total, identifying pica is a challenge and calls for an expert’s intervention for proper diagnosis.

Possible Complications Of Pica

Indiscriminate eating of non-foods may lead to any of these complications (9) (10) (11) (12):

  • Lead poisoning, if the child consumes paint or sand contaminated with lead.
  • Gastrointestinal complications such as constipation, ulcerations, perforations, diarrhea, parasites, nutrient malabsorption and bowel obstruction
  • Intestinal obstruction from eating something that can injure or block the intestines.
  • Mouth injury when the child swallows or eats some sharp or hard substance.
  • Dental erosion as coarse substances harm the teeth while chewing.
  • Infections from eating feces or dirt.
  • A Bezoar, referring to a mass of indigestible material such as cloth, hair, etc. trapped inside the body, most often in the stomach.
  • Mercury poisoning due to the ingestion of tissue boxes and cigarette packages.

You can avoid these complications with timely diagnosis and treatment of pica. Under these circumstances, you can’t delay taking the child to a doctor.

[Read: Malnutrition In Children]

When To See A Doctor?

You need to see a doctor when you find the aforementioned signs of pica in the child or they have any of the above complications. Consider it as an emergency and seek medical help immediately if:

  • Your child has consumed something harmful or poisonous such as lead or mercury.
  • Your child is regularly eating paint flakes.
  • The substance consumed is infectious, such as feces, that might lead to serious health implications.
  • The child is bloating from an intestinal blockage, such as a case of Bezoar.

Diagnosis Of Pica

There are no laboratory tests or a single approach diagnosis for pica. Hence, a pediatrician might use the below methods (13):

  • The doctor will primarily look at the child’s physical symptoms such as an upset stomach or any other bowel problems like bloating.
  • If a child falls in risk group, such as a child with developmental concerns, the doctor may ask the parents if they have seen their child eating nonfood items. If yes, then for how long.
  • They will try to know about the child’s medical history, psychological development, and behavioral issues.
  • The doctor may specifically want to know about the child’s food habits and the ambiance at home and school to understand the possible triggering factor.
  • If any suspected behavior has occurred for one month or more than that, the doctor may order tests, such as blood tests or X-rays to confirm pica. Blood tests check anemia, toxins in the blood, blockages in the intestines, and for iron and zinc deficiency. Insufficiency of these vitamins might be a cause for eating dirt (or clay) in certain cases. The doctor may also conduct a stool test to check for parasitic infections.
  • Sometimes, imaging or an X-ray may be required to identify what was consumed or to closely observe conditions such as obstructions in the intestines or bowels if any is suspected.

These steps will enable the doctor to diagnose pica and it’s complications and try to ascertain the cause behind it to the maximum probability.

Treatment Of Pica In Children

There is no one-way or direct treatment approach for pica, as it all depends on the underlying causes. The pica literature reports various treatments for pathological pica, such as nutritional, psychological, pharmacological, behavioral, ecological, and sensory approaches (14).

  • Nutritional intervention: In most cases, addressing the mineral or nutrient deficiencies through dietary changes may resolve the pica problem in the child. If dietary intervention is not sufficient, supplements could also be considered under the guidance of a pediatrician.
  • Psychological intervention: Counseling, behavioral therapy, and psychotherapy may be recommended for individuals in whom pica is believed to be attributable to emotional or psychological disturbances.
  • Pharmacological intervention: Medicines may be prescribed to reduce abnormal eating patterns if pica is linked with an intellectual or developmental disability in a child.
  • Behavioral intervention: Several behavioral approaches have been reported in the literature. If pica is found to be associated with the behavioral issues, the doctor may recommend consultation from a psychologist. This approach though, is considered more useful for children with developmental disabilities.
  • Sensory intervention: Sensory characteristics of a non-food item when identified can help in finding the edible replacements for it, which then will help in treating the condition.

[Read: Anemia Causes In Children]

Pica usually disappears as children get older if it is not due to neuro or developmental disorder. But in some cases, it may continue to bother during early adolescence and adulthood too, especially in people with developmental issues. Hence, be observant and maintain a safe home environment, besides continuing with the medical treatment.

Has your child ever had this condition? How did you deal with it? Share your experience with us.

References

1. Yasir Khan and Glenn Tisman; Pica in iron deficiency: a case series; Journal of Medical Case Reports.
2. Sekar Pasupathy and Srujana Swarna;Clinical profile, sociodemographic and biochemical determinants of PICA among 1 to 5 aged children attending a tertiary care hospital;International Journal of Contemporary Pediatrics,Vol. 5 (6) (2018)
3. Annette E. Chalker; The Psychopathology of Pica: Etiology, Assessment, and Treatment;Inquiries Journal (2017)
4. Shweta Advani et al.;Eating everything except food (PICA): A rare case report and review;National Centre for Biotechnology Information (2014)
5. Matson JL1, Hattier MA, Belva B, Matson ML; Pica in persons with developmental disabilities: approaches to treatment; NCBI.
6. Pica; National Eating Disorders Association.
7. Frances K. Millican et al.;Study of an oral fixation: Pica;Science Direct
8. Pica; MedlinePlus
9. Pica;Kids Health, Nemours (2014)
10. Anderson JE1, Akmal M, Kittur DS; Surgical complications of pica: report of a case of intestinal obstruction and a review of the literature;National Centre for Biotechnology Information (1991)
11. Ramnik Patel, Shiva Jayakumar, Manasvi Upadhyaya, David Drake; Pediatric Gastro-Duodenal Fabric Bezoar; Department of Pediatric Surgery, Evelina London Children’s Hospital St Thomas’ Hospital, London, UK.
12. Bruce E. Johnson; Chapter 148Pica; Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition; National Centre for Biotechnology Information (1990)
13. Pica;Family Doctor;American Academy of Family Physicians
14. Lillian N. Stiegler;Understanding Pica Behavior:A Review for Clinical and Education Professionals;Semantic Scholars

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