Pica: Symptoms, Causes, and Treatment

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.

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
  

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

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)

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

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.