Pica is long-term eating of inedible things such as stones, coins, shampoo, clothes or cigarette butts.
The charity The Challenging Behaviour Foundation says research into the causes, assessment and treatment for pica are have been extremely limited.
Estimates vary from 4% to 26% of people with learning disabilities displaying pica symptoms. A desire to eat non-food items may also be experienced during pregnancy.
How is pica diagnosed?
If pica is suspected, medical evaluation is important to assess for possible intestinal blockages, as well as potential poisoning from ingested substances. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. The doctor may use certain tests - such as X-rays and blood tests - to look for poisons and other substances in the blood, and to check for blockages in the intestinal tract. The doctor also may test for possible infections caused by eating items contaminated with bacteria or other organisms. A review of the person's eating habits may also be conducted.
Before making a diagnosis of pica, the doctor will rule out other disorders such as learning difficulty, developmental disabilities or obsessive-compulsive disorder as the cause of the odd eating behaviour. This pattern of behaviour must last at least one month for a diagnosis of pica to be made.
Pica may be linked with iron and zinc deficiencies, so a doctor may recommend tests to rule these out as the cause of pica.
How is pica treated?
Given the risk of medical complications (such as lead poisoning) associated with pica, close medical monitoring is necessary throughout treatment of the eating behaviour. Close collaboration with a mental health team skilled in treating pica is also ideal for optimal treatment of these complex cases.
Special training about which foods are edible and which foods cannot be eaten through the use of positive reinforcement may help. Other strategies include offering other food to chew, such as gum or to provide a 'pic box' containing items which safe to ingest.
What complications are associated with pica?
There are many potential complications of pica such as:
- Certain items such as paint chips may contain lead or other toxic substances and eating them can lead to poisoning, which increases the child's risk of complications including learning disabilities and brain damage. This is the most concerning and potentially lethal side effect of pica.
- Eating non-food objects can interfere with eating healthy food, which can lead to nutritional deficiencies.
- Eating objects that cannot be digested such as stones can cause constipation or blockages in the digestive tract. Hard or sharp objects can also cause tears in the lining of the intestines.
- Bacteria or parasites from dirt or other objects can cause serious infections. Some infections can damage the kidneys or liver.
- Co-existing developmental disabilities can make treatment difficult.
What is the outlook for people with pica?
Pica usually begins in childhood and typically lasts for just a few months. However it is likely to be more difficult to manage in children who are developmentally disabled.
Can pica be prevented?
There is no specific way to prevent pica. However careful attention to eating habits and close supervision of children known to put things in their mouths may help detect the disorder before complications can occur.