What Is Pica?

A compulsive eating disorder involving eating nonfood items

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Pica is an eating disorder that is characterized by eating items other than food such as paint chips, dirt, paper, or hair. More specifically, those with pica swallow or ingest items that do not have any real nutritional value.

The condition is more common in children, but pica can also occur in adults; it is linked with some types of intellectual and developmental disabilities (such as autism spectrum disorder.

Pica is the compulsive eating of nonfood items.

Up to one-third of children between the ages of 1 and 6 may exhibit some type of pica eating disorder. It’s important to note that children under the age of 2 are not diagnosed with pica, because it’s common for toddlers and younger children to put foreign items in the mouth. Pica can occur in adults who crave having a specific type of texture in the mouth.

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.

Child with pica eats dirt or nonfood items
Charles Gullung / The Image Bank / Getty Images

Pica Symptoms / Characteristics

The symptoms of pica 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 in the stomach (or abdominal cramping which can indicate that there may be an intestinal blockage)
  • Constipation
  • Diarrhea
  • Stomach ulcers (which may cause blood in the stools)
  • Symptoms of lead poisoning (if paint chips that contain lead are ingested)
  • Injuries to teeth (such as broken or fractured teeth from chewing on hard nonfood items)
  • An intestinal blockage (from eating nonfood items that cannot be digested and end up blocking up the intestine)
  • Infections (caused by germs and/or parasites that enter the body from the nonfood item that is swallowed)
  • Fatigue
  • Behavior problems
  • School problems
  • Other symptoms of lead poisoning or poor nutrition

Note, 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.

Call your doctor or 911 if there are signs of choking or severe pain.

What Do People With Pica Eat?

Common nonfood 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 Legos)
  • Rubber bands
  • Shampoo
  • Cloth
  • String
  • Wool
  • Talcum powder
  • Gum

Diagnosis

There are no specific lab tests to diagnose pica; diagnosis is made primarily from taking the history of the patient as well as from reports from family members (particularly for children with pica).

Diagnostic Tests

Some tests that are conducted for those who are suspected to have pica may include:

  • Blood tests: To evaluate the possibility of anemia, low zinc or iron levels
  • Stool samples: To test for intestinal bleeding from damage caused by swallowing nonfood items
  • Intestinal blockage evaluation: Done by performing X-rays or other imaging tests
  • Lead levels: To evaluate for lead poisoning in instances in which the person with pica eats paint chips
  • 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 that is not part of a culturally supported or socially normal practice (some cultures commonly eat clay for medicinal purposes as part of their cultural background)
  • Eating nonfood items must be developmentally inappropriate (for example, a child who is under 2 years of age commonly puts nonfood items in the mouth and therefore would not be diagnosed with pica until after age 2)
  • The type of nonfood substances that are ingested often change according to a person's age and the availability of nonfood items.

Causes

Although the exact cause of pica is unknown, experts know that 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 (OCD)
  • 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 carvings
  • Stress, such as in kids who have been abused or neglected or in those living in severe poverty
  • Pregnancy, on rare occasions people who are pregnant 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 U.S.

Causes of Pica in Children With Autism

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

  • 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.

Treatment

The treatment of pica varies depending on the underlying factors linked with the condition. It's important for the healthcare provider to address the symptoms that often result from pica; these symptoms differ, depending on which nonfood items are being ingested. Common symptoms that require treatment for those with pica include:

  • Medications for constipation or diarrhea
  • Treatment of stomach ulcers
  • Antibiotic treatment for Infections
  • Nutritional supplementation for nutritional deficiencies
  • Addressing other medical problems (such as lead poisoning)

Pica Behavior Treatment

Pica behavior has similar features to bulimia, trichophagia, and obsessive-compulsive disorder. Treatment modalities that address the pica behavior itself may include:

  • A referral to a mental health/behavioral health specialist
  • Behavior modification program: Such as redirecting the child’s attention away from the nonfood object and giving rewards for selecting food items instead of nonfood items
  • Medications 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 (ABA), which is a type of therapy aimed at improving specific behaviors
  • A pediatrician who specializes in the treatment of behavioral issues

Outlook (Prognosis)

The success rate for the treatment of pica varies quite a bit, depending on the underlying causes/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.

Treatment for pica has been found to be more successful in children who have undergone a medical assessment and behavioral evaluation by a mental health/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

Coping with a child who has pica can be very challenging, to say the least. It’s important to reach out and find experienced local professionals, trained in treating compulsive behavior conditions, such as pica.

There are many strategies that can be put into place to help empower parents to better manage the situation, this, in turn, lowers stress and may help to facilitate positive coping.

Educating yourself on the specific underlying factors pertaining to your child’s individual situation may also be an effective way to help alleviate stress. For example, if you have a child with autism, there are some proven strategies that can help you take control of the situation (instead of feeling helpless over it).

Some examples include:

  • Blocking: A strategy involving 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 reduce pica for some kids.
  • Providing frequent snacks at regular time intervals (such as every half hour or every hour): This may help because more frequent snacks can provide options to the child (other than eating nonfood items).
  • Give rewards (such as stickers): Give a reward for abstaining from eating nonfood items for a specific period of time. Positive reinforcement is a proven strategy that can help parents change unwanted behaviors in their child.

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

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Article Sources
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