How Pica Is Diagnosed

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Pica is a feeding disorder in which someone eats nonfood substances that have no nutritional value, such as paper, dirt, or sand.

People with pica don’t usually avoid regular food, meaning they may still be getting all the nutrients they need. However, some nonfood items that they consume can be very dangerous, especially if eaten in large quantities. If you’re concerned about yourself or someone else having pica, you should visit your doctor as quickly as possible so that they can refer you for appropriate treatment.

The following is a look at the different elements that help to diagnose pica.

Happy dirty child play with sand on family beach vacation


Denis Moskvinov / Getty Images

Pica is most commonly seen in children, with up to one-third of those under age 6 exhibiting signs of it. Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron and zinc, may trigger unusual cravings.

Professional Screenings

If your child is compulsively eating nonfood items, speak to your primary care physician or pediatrician. They will take a comprehensive medical history and interview family members to get a complete picture of the situation. The details a clinician will seek include:

  • The type of substance
  • Amount
  • Duration of exposure
  • Settings where behavior usually happens
  • The source of the substance
  • Symptoms of toxicity

They will also perform a physical examination. While in most cases the results of the physical exam will be normal, they should look for signs of poisoning or other medical complications. These can be classified into four main groups.

  • Manifestations of toxic ingestion: Lead poisoning is the most common poisoning associated with pica and can often be a result of eating paint chips or flakes. Most patients are asymptomatic, and the signs can be very subtle.
  • Manifestations of infection or parasitic infestation: Toxocariasis and ascariasis are the most common parasitic infections associated with pica and can be a result of eating contaminated dirt or feces. The clinical manifestations relate to the number of larvae ingested and the organs to which the larvae migrate.
  • Gastrointestinal manifestations: These may include bowel problems, perforations, and intestinal obstructions caused by bezoar formation (hairballs or concretions of other indigestible substances found in the stomach).
  • Dental manifestations: Presentation may include severe abrasion and other mechanical damage to teeth from chewing nonfood substances.

Risk factors

Pica itself rarely impairs social functioning, but it often occurs in people with other developmental or mental health disorders that do impair functioning (such as autism spectrum disorder, intellectual disability, and schizophrenia). Pica can also be linked with several other conditions, including:

Diagnostic criteria (DSM-5)

A physician will use the Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook that states criteria for diagnosing mental disorders. The most recent edition, the DSM-5, classifies pica under feeding and eating disorders, and the diagnostic criteria are as follows:

  • Persistent eating of non-nutritive, nonfood substances over a period of at least one month.
  • The eating of such substances is inappropriate to the developmental level of the individual.
  • The eating behavior is not part of a culturally supported or socially normative practice.
  • If the behavior occurs within the context of another mental disorder or medical condition (for example, schizophrenia, autism, or pregnancy), it is sufficiently severe to warrant independent clinical attention.

A minimum age of 2 years is suggested for the diagnosis. In children ages 18 months to 2 years, the ingestion and mouthing of non-nutritive substances is common and is not considered pathologic.

Labs and Tests

No specific laboratory studies are indicated in the evaluation of pica. However, the doctor may order certain lab tests to assess the consequences of the condition, depending on the characteristics and nature of what was eaten and the resulting medical condition.

Further investigations will likely be based on the specific substance ingested and the clinical findings. The American Academy of Pediatrics recommends that routine screening of blood lead concentrations be performed in children who live in residential areas where at least 27% of the houses were built before 1950.

Blood lead concentration should be checked in children:

  • With signs or symptoms of poisoning
  • With a history of ingestion of lead-based paints
  • When environmental exposure is suspected

Blood tests to evaluate the possibility of anemia or low zinc may also be carried out.

Imaging studies may be useful if there is a suspicion that certain objects have been ingested or there are clinical signs of gastrointestinal obstruction. These may include:

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

Self/At-Home Testing

If you are concerned that your child may be experiencing symptoms of pica, it’s essential that you reach out to a medical professional.

While there are online resources and screenings, they do not always come from reliable sources and cannot definitively diagnose any medical or mental health condition.

If you pay close attention to eating habits and supervise children who tend to put things into their mouths, you may be able to catch the disorder early, before complications can happen. If your child has been diagnosed with pica, you can reduce their risk of eating nonfood items by keeping those items out of reach in your home. Be sure to monitor your child’s outside play, as well.

A Word From Verywell

If you or your child is experiencing pica, it’s important to inform your physician and speak to a mental health professional. If left unmonitored and untreated, pica can be dangerous. The success rate for the treatment of pica varies and depends on the underlying causes/related factors. In kids, pica usually improves as they grow up. But for those with a mental health illness or developmental disorder, it commonly continues into the teenage years or even into adulthood.

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