Pica

Definition

Pica is a pattern of eating non-food materials, such as dirt or paper.

Causes

Pica is seen more in young children than adults. Between 10 and 32% of children ages 1 - 6 have these behaviors.

Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron deficiency anemia and zinc deficiency, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

Symptoms

Children and adults with pica may eat:

• Animal feces
• Clay
• Dirt
• Hairballs
• Ice
• Paint
• Sand

This pattern of eating must last for at least 1 month to fit the diagnosis of pica.

Exams and Tests

There is no single test for pica. However, because pica can occur in people who have lower-than-normal nutrient levels and poor nutrition (malnutrition), the health care provider may test blood levels of iron and zinc.

Blood tests can also be done to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust to screen for lead poisoning.

The health care provider may test for infection if the person has been eating contaminated soil or animal waste.

Treatment

Treatment should first address any missing nutrients or other medical problems, such as lead poisoning.

Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets positive reinforcement for eating normal foods.

Medications may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability.

Outlook (Prognosis)

Treatment success varies. In many cases, the disorder lasts several months, then disappears on its own. In some cases, it may continue into the teen years or adulthood, especially when it occurs with developmental disorders.

Possible Complications

• Bezoar (a mass of undigestible material trapped inside the body, usually in the stomach)
• Infection
• Intestinal obstruction
• Lead poisoning
• Malnutrition

When to Contact a Medical Professional

Call your health care provider if you notice that a child (or adult) is eating non-food materials.

Prevention

There is no specific prevention. Getting enough nutrition may help.

References

Katz ER, DeMaso DR. Pica. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.2.

Ginder GD. Microlytic and hypochromic anemias. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 162. 

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