N U T R I T I O N   A C T I O N

Pica In Young Children

As a childcare provider, you have seen infants, toddlers, and preschoolers put objects into their mouths. Young children are naturally curious, and oral exploration is one way they learn about their environment.

Very young children are not able to look at an object and determine if it is edible, so they give things they are interested in the “taste test.” Eventually, through their own development and trial and error, most children begin to discriminate between food and inedible objects and find other ways to explore and satisfy their curiosity.

Children younger than age two, especially those who are teething, will chew on non-food items and may try to eat them. This is considered developmentally appropriate for their age. Although it varies, most children generally lose the desire to put things in their mouths around age two.

What Is Pica?

Some young children have a condition called pica (pie-kuh) that goes beyond normal oral exploration of inedible objects. Some children may crave and eat non-food substances. If this continues, they are considered to have pica.

A person with pica may crave and eat a wide variety of items, including clay, dirt, sand, rocks, hair, plastic, pencil erasers, paper, paint chips, cornstarch, plaster, coal, chalk, wood, toothpaste, glue, soap, fingernail clippings, burned matches, coffee grounds, string, baking soda, feces, and cigarette butts.

Who Is at Risk for Developing Pica?

Pica has existed since ancient times and is found across cultures in both sexes and in all ages. It is most common in children, especially two and three-year-olds.

Some research indicates that 25-33 percent of young children have pica at some point. Young children with pica are most likely to eat paint, plaster, string, hair, and cloth, while older children are more likely to consume animal droppings, sand, insects, leaves, rocks, and cigarette butts.

Individuals with developmental disabilities have an increased chance of the condition. The Autism Research Institute estimates that 30 percent of children with autism have moderate to severe pica.

People with mental health issues (such as obsessive-compulsive disorder and schizophrenia) and nutritional deficiencies also are at increased risk. Other at-risk groups include pregnant women, dieters, individuals who are malnourished, people who have epilepsy, and children who experience neglect, lack of supervision, and insufficient food and nutrition.

Children who have had a brain injury also may develop the condition. Pica becomes less prevalent as children grow older, and most adult cases are found in adults who are mentally or developmentally disabled.

Why Is Pica Dangerous?

Individuals with pica are at risk for serious health complications, even if the inedible item itself is considered harmless. Swallowing non-food items poses a choking hazard. Once the object is consumed, it begins moving through the digestive tract, where it can cause problems.

Metal objects that are ingested are associated with perforation of the bowel, and eating sand or soil has been linked to gastric pain and bleeding. Inedible objects can form a mass in the stomach that blocks the entrance to the intestine.

Eating dirt or feces can cause parasitic infections. If the substance is toxic or contaminated, a medical emergency could result. Lead toxicity is the most frequent poisoning linked to pica. Eating paint chips from older buildings can result in lead poisoning; which has neurological and gastrointestinal complications ranging from headaches and abdominal pain to seizures, coma, and death.

Illness, fever, and infection can result from eating soil and non-food items. Chewing and eating hard, inedible objects can damage teeth and gums.

There also are nutritional problems associated with pica. Many children who have pica also have low levels of zinc, calcium, or iron; and some children who have pica also have iron-deficiency anemia. Children who have pica also may be less likely to eat nutritious foods and suffer from malnutrition.

What Causes Pica?

The cause of pica is not known, but there are many theories, including nutritional deficiencies, developmental disorders, psychological and mental disorders, emotional problems, biochemical deficiencies, and hunger. It appears that pica is sometimes linked to nutritional deficiency (especially iron and zinc). In those cases, pica disappears when the deficiency is treated.

This is not always true, however, particularly among people with autism and developmental disabilities; and it seems that there are a number of physical, psychological, and mental conditions that can trigger pica.

Treating and Diagnosing Pica

There is no diagnostic test for pica. Typically, a person with pica is referred to a physician for some other condition that is linked to pica, like iron deficiency anemia, lead poisoning, or malnutrition. Pica is then discovered during diagnosis and treatment.

Since pica can result in life-threatening conditions like lead poisoning and bowel obstruction, it is sometimes discovered in the emergency room when X-rays and other imaging tests show inedible objects in the digestive tract. For young children with pica, parents or caregivers are an important source of information about the child’s eating habits and behaviors.

There is no single specific treatment for pica. In some cases, behavioral therapy and psychological counseling have been successful. When pica occurs with iron deficiency anemia, treating the iron deficiency often stops the pica behavior. When pica occurs with a mental health issue, such as schizophrenia or depression, treatment of the mental health problem may reduce pica behavior.

Ways to Help

An essential first step to support a child with pica is to update staff on prevention and first aid procedures for poisoning and choking. Make certain the phone number for the Poison Center (1-800-222-1222) and other emergency numbers are posted and accessible.

Documentation of a child’s eating habits is a valuable source of information for physicians when a child has pica, so maintain thorough, detailed records. Encouraging children to eat only in designated areas of the room may help a child with pica begin to differentiate between food and inedible objects. Providing close supervision is important to discourage consumption of non-food items, along with “pica-proofing” the environment and removing objects the child is prone to eat.

Marna Holland, Ed.D., Parent educator, Asheville City Schools Preschool in Asheville, North Carolina

Internet Resources

American Dental Hygienists, www.adha.org/CE_courses/course8/pica.htm

California Childcare Health Program, www.ucsfchildcarehealth.org/pdfs/newsletters/2005/CCHPNewsNov_Dec2005.pdf

Children, Youth and Women’s Health Service, www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=304&id=1513

Eating Disorders, www.healthyplace.com/Communities/Eating_Disorders/type_pica.asp

Encyclopedia of Mental Disorders, www.minddisorders.com/Ob-Ps/Pica.html

KidsHealth, www.kidshealth.org/parent/food/problems/pica.html

Medline Plus, www.nlm.nih.gov/medlineplus/ency/article/001538.htm

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