Many young kids put nonfood items in their mouths at one time or
another. They're naturally curious about their environment and
might, for instance, eat some dirt out of the sandbox.
Kids with pica, however, go beyond this innocent exploration of
their surroundings. As many as 25% to 30% of kids (and 20% of those
seen in mental health clinics) have the eating disorder pica, which
is characterized by persistent and compulsive cravings (lasting 1
month or longer) to eat nonfood items.
About Pica
The word pica comes from the Latin word for magpie, a bird known
for its large and indiscriminate appetite.
Pica is most common in people with developmental disabilities,
including
autism
and mental retardation, and in children between the ages of 2 and
3. Although kids younger than 18 to 24 months can try to eat
nonfood items, it isn't necessarily considered abnormal at that
age.
Pica is also a behavior that may surface in children who've
had a brain injury affecting their development. It can also be a
problem for some pregnant women, as well as people with
epilepsy.
People with pica frequently crave and consume nonfood items such
as:
- dirt
- clay
- paint chips
- plaster
- chalk
- cornstarch
- laundry starch
- baking soda
- coffee grounds
- cigarette ashes
- burnt match heads
- cigarette butts
- feces
- ice
- glue
- hair
- buttons
- paper
- sand
- toothpaste
- soap
Although consumption of some items may be harmless, pica is
considered to be a serious eating disorder that can sometimes
result in serious health problems such as
lead poisoning
and
iron-deficiency anemia
.
Signs of Pica
Look for these warning signs that your child may have pica:
- repetitive consumption of nonfood items, despite efforts to
restrict it, for a period of at least 1 month or longer
- the behavior is considered inappropriate for your child's
age or developmental stage (older than 18 to 24 months)
- the behavior is
not
part of a cultural, ethnic, or religious practice
Why Do Some People Eat Nonfood Items?
The specific causes of pica are unknown, but certain conditions
and situations can increase a person's risk for pica:
-
nutritional deficiencies
, such as iron or zinc, that may trigger specific cravings
(however, the nonfood items craved usually don't supply the
minerals lacking in the person's body)
-
dieting
- people who diet may attempt to ease hunger by eating nonfood
substances to get a feeling of fullness
-
malnutrition
, especially in underdeveloped countries, where people with pica
most commonly eat soil or clay
-
cultural factors
- in families, religions, or groups in which eating nonfood
substances is a learned practice
-
parental neglect, lack of supervision, or food
deprivation
- often seen in children living in poverty
-
developmental problems
, such as mental retardation, autism, other developmental
disabilities, or brain abnormalities
-
mental health conditions
, such as
obsessive-compulsive disorder (OCD)
and schizophrenia
-
pregnancy
, but it's been suggested that pica during pregnancy occurs
more frequently in women who exhibited similar practices during
their childhood or before pregnancy or who have a history of pica
in their family
Theories about what causes pica abound. One is that a
nutritional deficiency, such as iron deficiency, can trigger
specific cravings. Evidence supports that at least some pica cases
are a response to dietary deficiency - nutritional deficiencies
often are associated with pica and their correction often improves
symptoms. Some pregnant women, for example, will stop eating
nonfood items after being treated for iron deficiency anemia, a
common condition among pregnant women with pica.
However, not everyone responds when a nutritional deficiency is
corrected, which may be a consequence of pica rather than the
cause, and some people with pica don't have a documented
nutritional deficiency.
Known as
geophagia
, eating earth substances such as clay or dirt is a form of pica
that can cause iron deficiency. One theory to explain pica is that
in some cultures, eating clay or dirt may help relieve nausea (and
therefore, morning sickness), control
diarrhea
, increase salivation, remove toxins, and alter odor or taste
perception.
Some people claim to enjoy the taste and texture of dirt or
clay, and eat it as part of a daily habit (much like smoking is a
daily routine for others). And some psychological theories explain
pica as a behavioral response to
stress
or an indication that the individual has an oral fixation (is
comforted by having things in his or her mouth).
Another explanation is that pica is a cultural feature of
certain religious rituals, folk medicine, and magical beliefs. For
example, some people in various cultures believe that eating dirt
will help them incorporate magical spirits into their bodies.
None of these theories, though, explains every form of pica. A
doctor must treat each case individually to try to understand
what's causing the condition.
When to Call the Doctor
If your child is at risk for pica, talk to your doctor. If your
child has consumed a harmful substance, seek medical care
immediately. If you think your child has ingested something
poisonous, call Poison Control at (800) 222-1222.
A child who continues to consume nonfood items may be at risk
for serious health problems, including:
- lead poisoning (from eating paint chips in older buildings
with lead-based paint)
- bowel problems (from consuming indigestible substances like
hair, cloth, etc.)
- intestinal obstruction or perforation (from eating objects
that could get lodged in the intestines)
- dental injury (from eating hard substances that could harm
the teeth)
- parasitic infections (from eating dirt or feces)
Medical emergencies and death can occur if the craved substance
is toxic or contaminated with lead or mercury, or if the item forms
an indigestible mass blocking the intestines. Pica involving
lead-containing substances during pregnancy may be associated with
an increase in both maternal and fetal lead levels.
What Will the Doctor Do?
Your doctor will play an important role in helping you manage
and prevent pica-related behaviors, educating you on teaching your
child about acceptable and unacceptable food substances. The doctor
will also work with you ways to to restrict the nonfood items your
child craves (i.e., using child-safety locks and high shelving, and
keeping
household chemicals
and medications out of reach). Some kids require behavioral
intervention and families may need to work with a psychologist or
other mental health professional.
Depending on a child's age and developmental stage, doctors
will work with kids to teach them ways to eat more appropriately.
Medication may also be prescribed if pica is associated with
significant behavioral problems not responding to behavioral
treatments.
Your doctor may check for anemia or other nutritional
deficiencies, if indicated. A child who has ingested a potentially
harmful substance, such as lead, will be screened for lead and
other toxic substances and might undergo
stool testing
for parasites. In some cases, X-rays or other imaging may be
helpful to identify what was eaten or to look for bowel problems,
such as an obstruction.
Fortunately, pica is usually a temporary condition that improves
as kids get older or following pregnancy. But for individuals with
developmental or mental health issues, pica can be a more prolonged
concern.
Following treatment, if your child's pica behavior continues
beyond several weeks despite attempts to intervene, contact your
doctor again for additional treatment. Remember that patience is
key in treating pica because it can take time for some kids to stop
wanting to eat nonfood items.
Reviewed by:
Mary L. Gavin, MD
Date reviewed: December 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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