According to the National Association of Anorexia Nervosa and Associated Disorders, about 24 million people in the United States suffer from an eating disorder. More than 10,000 deaths annually are attributed to eating disorders, such as anorexia and bulimia nervosa, binge-eating disorder, rumination syndrome and avoidant/restrictive food intake disorder.
Several forms of eating disorders affect children and adolescents. Among them is pica, a condition that causes people to eat non-food items that have no nutritional value, such as:
- Dirt or soil
- Laundry detergent
- Paint chips
- Rocks or pebbles
Individuals with developmental problems, mental health issues or malnutrition or hunger, those lacking certain nutrients and those suffering from stress or abuse are most susceptible to having pica disorder. Their compulsion to eat non-food items is generally uncontrollable, and they are often, but not always, drawn to the same thing. For example, someone who craves chalk will likely continue eating chalk and not venture toward other items, such as soap or metal.
“Most people with pica generally go for one thing, such as paint they peel off the wall,” said Ayodeji Otegbeye, M.D., a pediatrician with Pediatrix® Urgent Care of Florida. “There may be lots of other objects around them, but if their craving is for paint, they will leave the other items alone and continue to peel paint from the wall and eat it. They tend to be compulsive about one or two things only.”
Is Pica a Common Eating Disorder?
While the prevalence of pica is unclear, a recent study revealed that pica:
- Occurs in up to 68% of pregnant women
- Affects 18.5% of children
- Is present in 10% of children older than 12
- Impacts up to 50% of toddlers ages 18 to 36 months
- Affects 10% of individuals who have developmental issues
Pica can Affect Anyone
Anyone at any age can have pica. However, those most prone to developing the disorder include:
- Those with certain mental health illnesses (primarily schizophrenia), developmental disorders (especially autism spectrum disorder) and intellectual disabilities
- Children under 6 years
- Pregnant women (typically, expectant moms with pica chew a lot of ice)
While pica is deemed fairly common, health care professionals may miss this diagnosis, especially when they aren’t made aware of some common symptoms.
The most prominent symptom of pica is the compulsive eating of non-food items. As a result of pica, other secondary symptoms may arise, including:
- Electrolyte imbalance
- Intestinal blockage or perforation
- Irregular or abnormal heart rhythms (arrhythmias)
- Lead poisoning
- Low iron (anemia)
- Roundworm infection (ascariasis)
How is Pica Diagnosed in Children?
Several signs point to pica disorder, such as:
- The child has been eating non-food items for longer than a month
- The behavior is out of character for the child's age or developmental stage
- The child has risk factors for pica, such as intellectual or developmental disabilities
When pica is suspected, health care providers may run a series of tests to make an accurate diagnosis, including:
- Checking for nutritional deficiencies (iron, calcium, zinc)
- Testing lead levels in the blood
- Checking for ova (eggs) and parasites through stool tests
- Imaging, such as X-rays, to determine if there are bowel issues, such as a blockage
“There are five simple questions a pediatrician or even parents can ask to determine if a child is at risk of having pica,” said Dr. Otegbeye. “If the answer to one or two of the questions is ‘yes,’ it raises suspicion for pica.”
- Does the child search the environment for items to place in his or her mouth?
- Does the child repeatedly eat non-food items?
- Does the child frequently hold non-edible items in his or her mouth (e.g., rocks, wood chips)?
- Do other people, such as grandparents, babysitters or teachers, report that the child places non-edible items in his or her mouth?
- Do you find non-edible items in the child’s stool (e.g., beads, small rocks)?
Also, as part of a thorough assessment, additional questions will help determine if a child is at risk of pica disorder, including:
- Is the child under a lot of stress?
- Are there cultural features (e.g., cultural beliefs or social norms) that may contribute to pica behavior?
- What is the child’s socioeconomic status?
- Does the child have underlying mental health or familial psychiatric disorders?
- Does the child have poor eating habits that would cause a nutritional deficiency?
- Does the child have sufficient access to healthy foods?
The Dangers of Pica
In general, pica is not dangerous. However, depending on what a person eats, it could be hazardous and even fatal. For example, if a person eats chalk or paper, chances are, no harm will come to them. Adversely, several objects, such as metals, soil, feces, hair and paint, could be dangerous if consumed regularly.
“If a person continually eats hair, the hair can cause blockages and even tears in the digestive tract,” said Dr. Otegbeye. “Some items may bind food, so it doesn’t get well absorbed, leading to malnutrition. Metals can wreak havoc by causing obstructions or perforations of the bowels. Paint may cause lead poisoning. Dirt, soil and feces could lead to parasite infections. So, many objects pose various health risks for pica patients and, in rare cases, could be fatal.”
Children often outgrow pica as they learn the difference between items that should and should not be eaten. Parents or guardians should supervise children with developmental, intellectual or mental health issues and eliminate any non-food items they crave.
Various types of therapy have yielded successful results in treating pica, including:
- Aversive therapy — Teaches how to refrain from eating non-food items through minor consequences (aversions) while rewarding healthy eating behaviors
- Behavioral therapy — Teaches coping methods and strategies to help change eating behaviors
- Differential reinforcement — Teaches to replace pica behaviors with other behaviors and activities
“Most kids outgrow pica,” said Dr. Otegbeye. “It tends to abate over a period of a few years. So, once any nutritional issues have been resolved, I would recommend seeing a neurobehavioral specialist who specializes in different types of behavioral therapies that have been studied.”
Who Treats Pica?
Depending on the severity of the disorder, primary pediatricians can often treat patients with pica. If pica stems from nutritional deficiencies, for example, the pediatrician can effectively treat the patient. If the patient requires care from a specialist, a neurobehavioral specialist, child psychiatrist or pediatric toxicologist may be recommended.
Pica is a Medical Condition, Not a Choice
Individuals with pica don’t necessarily eat non-food items because they want to; it’s a medical condition.
“I would not punish a child who has pica or give them time-out,” said Dr. Otegbeye. “Instead, parents should visit with their child’s pediatrician and get them help for the condition. Also, there are often underlying health conditions facing children with pica. I would recommend a professional evaluation and empathy.”