- What is pica?
- Causes of pica in children
- Pica signs in kids
- Possible complications of pica
- Diagnosis of pica
- Treatment of pica in children
Children are naturally curious. Up to a particular developmental stage, they tend to put almost any object in their mouth as they try to understand the world. Once that stage passes, kids know what to put in their mouth 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.
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.
Pica disorder can surface at any time during the childhood or adulthood, especially in those with special needs like autism, epilepsy or other developmental disabilities. Studies have found it to be more prevalent among the lower socioeconomic classes (1).
Children with pica eat a variety of substances such as:
- Coffee grounds
- Cigarette ashes
- Talcum powder
- Animal feces
- Rubber bands
Causes of Pica in children
- Gastrointestinal distress: Children with GI distress find it soothing to eat non-food items, especially earth.
- Nutritional deficiency: Iron deficiency, zinc or calcium deficiency may trigger specific cravings.
- 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 can increase their anxiety and distress.
- Malnutrition: Deficiency in the intake of nutritious food triggers cravings for soil or clay. Though soil/ clay does not have the nutrients to meet the deficiencies, it binds iron in the gastrointestinal tract, thus soothing the cravings.
- Oral fixations: Some children have an oral fixation, an obsessive urge to put things into their mouth. This is common in very young kids.
- Mental and developmental growth delays: Children, especially those with autism or other developmental conditions, often tend to eat unhygienic or non-food materials like dirt or paper due to their ability to differentiate (5).
- Lack of proper appetite stimulation: If your kid is a picky eater and does not eat properly, he/she may feel hungry and eat non-food objects to feel full.
- Poor parental attention: Parental neglect is a major cause seen mostly in people living in poverty where they fail to supervise their kid’s diet.
If your child is eating non-food items, then observe the symptoms of pica.
Pica Signs in Kids
These are some signs that your child may have pica (6):
- Eating non-food substances for more than a month despite efforts to stop it.
- Their eating pattern and cravings are not on par with their age or behavior. Children below two years of age usually do have pica even if they are ingesting non-food items.
- Your child’s eating habits are not a part of some ethnic or cultural food tradition. For example, in parts of Africa and some rural areas of the US eating clay is believed to cure gastrointestinal problems (2).
- 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.
Depending on the substances the child is eating, they may have a few other symptoms such as:
- Stomach pain, nausea and bloating due to intestinal or stomach blockage.
- Poor nutrition and fatigue.
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.
Possible Complications Of Pica
- 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 kid swallows or eats some sharp or hard substance.
- Dental erosion as the coarse substances harm the teeth while chewing.
- Infections from eating feces or dirt.
- A Bezoar is a ball of ingested foreign object mostly fiber, cloth or hair. As they are indigestible, they get accumulated in the stomach failing to pass through the intestines.
- Mercury poisoning due to the ingestion of tissue boxes and cigarette packages.
You can avoid these complications with timely diagnosis and treatment of pica. And under certain circumstances, you can’t delay taking the child to a doctor.
When to rush to a doctor?
Consider it as an emergency and seek medical help immediately if:
- Your child has consumed something harmful or poisonous.
- The substance consumed is toxic or contaminated with mercury or lead.
- The child is bloating from intestinal blockage.
Diagnosis Of Pica
- The primary investigation should be into possible causes like anemia, nutrient deficiency or any poisoning such as lead poisoning.
- The doctor will ask you about your child’s medical history, psychological development, and behavioral issues.
- The presence of GI problems such as constipation, diarrhea, abdominal pain, and vomiting.
- They will ask about the child’s general feeding and dietary habits.
- The doctor may specifically want to know about the child’s food habits and the ambiance at home and school, to understand if that is a possible triggering factor.
- Doctors may perform a developmental assessment on the child.
- The doctor may 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.
These steps will enable the doctor to diagnose pica and the cause behind it.
Treatment Of Pica In Children
There is no one-way or direct treatment approach for pica as it all depends on the underlying causes.
- In most cases, addressing the mineral or nutrient deficiencies through supplements and dietary changes will resolve the pica problem in the child.
- Medicines may be given to reduce abnormal eating patterns if your child’s pica is associated with developmental or intellectual disability.
- If pica is associated with behavioral issues then the doctor may ask you to consult a psychologist.
- You are trained in providing a safe environment at home, caregiving methods, dietary factors, physical activities, etc.
- The doctor will educate you on useful approaches such as keeping non-food items out of children’s access, having child safety locks, hiding the household chemicals or medicines from the child.
Pica usually disappears as children get older. 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.
2. Frances K. Millican, Emma M Layman, Reginald S. Lourie, and Lily Y. Takahashi; Study of an oral fixation: Pica
3. Annette E. Chalker; The Psychopathology of Pica: Etiology, Assessment, and Treatment.
4. Shweta Advani, Gulsheen Kochhar, Sanjay Chachra, and Preeti Dhawan; Eating everything except food (PICA): A rare case report and review; NCBI.
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. Pica tool kit for primary care providers; Autism Speaks Family Services Department.
8. Anderson JE1, Akmal M, Kittur DS; Surgical complications of pica: report of a case of intestinal obstruction and a review of the literature; NCBI.
9. Ramnik Patel, Shiva Jayakumar, Manasvi Upadhyaya, David Drake; Paediatric Gastro-Duodenal Fabric Bezoar; Department of Pediatric Surgery, Evelina London Children’s Hospital St Thomas’ Hospital, London, UK.
10. Bruce E. Johnson; Chapter 148Pica; Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition; NCBI.
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