Pica

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