Pica: Symptoms, Causes, and Treatment

People with a pica disorder eat non-food items like dirt, paint chips, and feces

Pica is an eating disorder that causes someone to crave and compulsively eat things that are not food, such as paint chips, dirt, paper, or hair. Depending on what is ingested, consumption of these non-food items can lead to intestinal blockages, toxic side effects, or other health issues.

Pica is usually temporary and can affect pregnant people and others with iron-deficiency anemia or other nutrient deficiencies who may crave certain minerals found in dirt, or eat earthy material like clay. It can occur in adults who crave a specific type of texture in the mouth. Pica disorder is also seen in people living with an autism spectrum disorder.

Pica in toddlers is common, with up to a third of kids ages 1 to 6 affected (though it is not diagnosed in those under age 2). In young children, it goes beyond just sampling nonfood items and briefly putting them in their mouth out of curiosity. The child regularly swallows it.

This article explains pica symptoms and health issues that may follow the ingestion of non-food material. It explains common types of the pica disorder and their causes, as well as pica treatment.

Verywell / Laura Porter

Pica Disorder Symptoms

Pica disorders lead to symptoms that have a broad range, but they are all linked with the impact of nonfood items that are ingested.

Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in nonfood items that are ingested. The symptoms may include:

  • Nausea
  • Pain or abdominal cramping in the stomach
  • Constipation
  • Diarrhea
  • Fatigue
  • Behavior problems
  • School problems

Most people with pica eat regular nutrient-filled foods in addition to ingesting nonfood items. But in many instances, those who are affected by pica are nutritionally malnourished.

Pica Complications

Because pica symptoms are linked to the substances ingested, some of these symptoms may lead to more serious complications.

These symptoms and conditions need to be evaluated more urgently by a healthcare provider. They include:

  • Intestinal blockage, when stomach pain does not resolve
  • Stomach ulcers, which may cause blood in the stools
  • Symptoms of lead poisoning, if paint chips that contain lead are ingested
  • Electrolyte imbalances, in rare cases leading to seizure
  • Injuries to teeth, such as broken or fractured teeth from chewing on hard nonfood items
  • Infections caused by germs, and/or parasites that enter the body from the nonfood item that is swallowed

Call 911 if you witness signs of choking or severe pain in someone with pica or experience them yourself.

What Do People With Pica Eat?

Pica types have different names, based on describing the type of non-food items that people eat. Pica disorder examples include pagophagia, which refers to eating ice, and geophagia, which refers to eating dirt and clay.

Common items ingested by people (children and adults) with pica include:

  • Dirt
  • Paper
  • Clay
  • Animal feces
  • Ice
  • Paint chips
  • Sand
  • Hair
  • Chalk
  • Plants or grass
  • Cigarette butts
  • Rocks
  • Toys (such as Lego bricks)
  • Rubber bands
  • Shampoo
  • Cloth
  • String
  • Wool
  • Talcum powder
  • Gum

Pica in Pregnancy

People who are pregnant are known to have a form of pica that may be caused by a craving for certain nutrients (such as minerals found in dirt). Iron and zinc deficiencies can trigger pica cravings. Another type of pica thought to be associated with nutrient cravings is called geophagy, which involves eating earthy substances such as clay.

Causes

Although the exact cause of pica is unknown, experts know there are some conditions that cause a person to be more at risk for developing pica. These include:

  • Developmental disorders and intellectual disabilities, such as autism spectrum disorder
  • Mental health conditions, such as schizophrenia or obsessive-compulsive disorder
  • Those with malnutrition or who suffer from hunger, resulting in low levels of nutrients such as iron and zinc, which can trigger specific types of cravings
  • Stress, such as in kids who have been abused or neglected or those living in severe poverty
  • During pregnancy when, rarely, people crave dirt (which may be related to an iron deficiency)

Pica Disorder and Autism

Pica disorders are more common in people with autism, certain intellectual disabilities, and mental health diagnoses. A study of 1,426 children living with ASD and 1,735 children with developmental disabilities (DD) compared these two groups with 1,578 children in the general population (GP). The ASD kids had pica disorders at a rate of 23.2%, which was 8.4% in DD kids and 3.5% in the GP kids.

Other Risk Factors

Pica can be linked with several other conditions, including:

  • Hair pulling (a disorder called trichotillomania)
  • Skin picking (a disorder called excoriation)

The overall number of people with pica is not clear, but it is thought to be more prevalent in developing countries than in the United States.

Causes of Pica in Children With Autism

Several factors have been linked with pica in kids with autism spectrum disorder. The reasons these kids often crave nonfoods may include the following.

  • Sensory feedback (also referred to as automatic reinforcement): This is the desire to eat nonfoods for a pleasurable feeling.
  • An inability to decipher between foods and nonfoods: Some children eat nonfood items because they believe they are edible foods.
  • Nutrient deficiency: This includes a lack of adequate levels of iron or zinc.

Diagnosis

Pica is not diagnosed on the basis of specific lab tests. A healthcare provider begins the diagnosis by taking a person's medical history and the reports from family members, particularly with children.

Other tests may then follow, based on symptoms and what the person may be eating.

Diagnostic Tests

Pica disorders may be diagnosed on the basis of tests that include:

  • Blood tests, to evaluate the possibility of anemia, low zinc or iron levels
  • Stool samples, to test for intestinal bleeding
  • X-rays or other imaging tests to check for intestinal blockage
  • Lead levels, to evaluate for lead poisoning if paint chips are ingested
  • Tests to check for parasites or bacteria from eating dirt or other items
  • Weight loss evaluation
  • Testing for nutritional deficiencies

Qualifying Factors for a Pica Diagnosis

The criteria of symptoms that qualify a person to be diagnosed with pica include:

  • Persistent eating of nonfood substances for one month or longer, even if the foods cause illness or discomfort such as nausea
  • Ingesting a nonfood substance when it's not part of a culturally or socially supported practice, as is true in cultures that commonly eat clay for medicinal purposes
  • Eating nonfood items when it is developmentally inappropriate. For example, children ages 2 years and under commonly put items in the mouth and would not yet be diagnosed with pica.

The type of nonfood substances that are ingested often change according to a person's age and the availability of nonfood items.

Pica Treatment

Pica disorder treatment varies depending on the underlying factors linked with the condition. It's important for healthcare providers to address the symptoms that often result from pica.

These symptoms differ, depending on which nonfood items are ingested. Common pica treatments include:

  • Medications for constipation or diarrhea
  • Treatment of stomach ulcers
  • Antibiotic treatment for infections
  • Nutritional supplements for nutrient deficiencies
  • Addressing other medical problems, such as lead poisoning

Behavioral Treatment for Pica

Pica disorder behaviors have similar features to symptoms and patterns of other conditions, such as bulimia or obsessive-compulsive disorder. It's been seen in people with bipolar disorder.

Treatments that address the pica behavior itself may include:

  • A referral to a mental health/behavioral health specialist
  • Behavior modification programs, to redirect a child’s attention away from the nonfood object and reward the choice of appropriate food items
  • Medication for managing behavioral problems, given to help reduce the urges and impulses to eat nonfood items

Is Pica a Form of OCD?

Obessive-compulsive disorder (OCD) behavior patterns don't explain all types and cases of pica disorder. However, OCD has been associated with pica symptoms, sometimes leading to an OCD diagnosis.

Professionals

Professionals trained in treating pica may include:

  • A behavior analyst, with experience in functional behavioral assessment and implementation of behavioral intervention
  • A psychologist with experience in applied behavior analysis, which is a type of therapy aimed at improving specific behaviors
  • A pediatrician who specializes in the treatment of behavioral issues

Outlook (Prognosis)

Pica disorder treatment may be successful, but it varies quite a bit depending on the underlying causes and any related factors. In kids, pica usually improves as they grow up. But for those with mental illness or developmental disorders, it commonly continues into the teenage years or even into adulthood.

Pica treatment has been found to be more successful in children who have undergone a medical assessment and behavioral evaluation by a mental health or medical professional. Behavioral assessments help to identify and treat associated problem behaviors, such as aggression.

A thorough medical evaluation can result in the effective treatment of underlying problems, such as nutritional deficiencies, which may end up resolving pica.  

Coping With Pica

Pica disorder in children can be very challenging for families. It’s important to reach out and find experienced local professionals trained in treating compulsive behavior conditions such as pica.

There are many strategies to help empower parents and, in turn, lower stress and build positive coping skills while dealing with specific issues.

Some examples for parents of children living with ASD include:

  • Blocking, or placing your hand on top of the child’s hand to prevent the child from putting the nonfood item into their mouth. This strategy helps to reduce pica for some kids.
  • Snacking at frequent, regular time intervals (such as every 30 or 60 minutes) can provide options to the child other than eating nonfood items.
  • Rewards, such as stickers, can be given when children refrain from pica behaviors. Positive reinforcement is a proven strategy to help parents change a child's unwanted behaviors.

Visit the Autism Speaks guide for parents to learn about other strategies to help kids who have autism deal with pica. There is also an online tool kit that provides more information on how parents can effectively manage challenging behaviors.

Frequently Asked Questions

  • Is pica linked to pregnancy?

    In rare cases, pica can occur during pregnancy. It is not directly caused by pregnancy, but more specifically, may be linked to anemia (iron deficiency) while pregnant. Pregnant women are at a higher risk of developing anemia due to the extra blood produced by the body to provide nutrients for a baby.

  • What causes pica?

    The specific causes of pica are unknown. However, certain conditions may cause a person to have a greater risk of developing pica. Examples include:

    • Disorders related to impaired mental function, such as intellectual disability, schizophrenia, and autism spectrum disorder (ASD)
    • Iron-deficiency anemia or malnutrition resulting in low levels of iron and zinc
    • Extreme stress
    • Trichotillomania disorder (hair pulling)
    • Excoriation disorder (skin picking)
  • How is pica treated?

    Pica treatment focuses on underlying causes. For example, if a person eats dirt because of a mineral deficiency, they may be given a nutritional supplement. Additionally, referring to a specialist or health professional trained in behavioral issues is an important step toward treating a person with a pica disorder.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Eating Disorders. (NEDA). Pica.

  2. MedlinePlus. Pica.

  3. Bedanie G, Tikue A, Thongtan T, Zitun M, Nugent K. Pica/Pagophagia-Associated Hyponatremia: Patient Presenting With Seizure. Cureus. 2020 Jul 21;12(7):e9330. doi:10.7759/cureus.9330.

  4. American Academy of Family Physicians. What is pica.

  5. Fields VL, Soke GN, Reynolds A, Tian LH, Wiggins L, Maenner M, et al. Pica, Autism, and Other Disabilities. Pediatrics. 2021 Feb;147(2):e20200462. doi:10.1542/peds.2020-0462. 

  6. Autism Speaks. Parent's guide to managing pica in children with autism.

  7. Bharti A, Mishra AK, Sinha V, Anwar Z, Kumar V, Mitra S. Paper eating: An unusual obsessive-compulsive disorder dimension. Ind Psychiatry J. 2015 Jul-Dec;24(2):189-91. doi:10.4103/0972-6748.181713. 

  8. Kids Health from Nemours. Pica.

  9. Khan Y, Tisman G. Pica in iron deficiency: a case seriesJ Med Case Rep. 2010;4:86. doi:10.1186/1752-1947-4-86

  10. American Pregnancy Association. Anemia during pregnancy.

By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.