Pica is an eating disorder that involves the consumption of non-food items. It is most common in children and affects between 10 and 30 percent of those under six. To be diagnosed with pica, a child must be at least two, as eating non-food objects is not unusual for younger children.
While pica is most common in young children, it affects other people, too. People with intellectual impairments are also at risk for developing pica, and it can affect pregnant women. Although pica is usually an isolated disorder, people diagnosed with OCD or schizophrenia are at a higher risk of developing it.
Researchers have not identified the causes of pica, but there are some known risk factors. They include underlying mental health disorders, pregnancy, nutritional deficiency, epilepsy, child neglect, low socioeconomic status, and a family history of psychiatric disorders. Pica can also be the result of stress or learned behaviors.
Although many people believe that pica is a direct result of micronutrient deficiencies, the relationship between the two is not well understood nor exclusive. The items that someone with pica eats may bind to the gut and prevent nutrient absorption, or the materials themselves may absorb the nutrients. Another theory is that the micro deficiencies cause people to seek out these minerals in non-food substances. While the causal effect between pica and these deficiencies has not been established, pica can be an early indicator of deficiencies.
In addition to ingesting non-nutritive substances, other symptoms of pica include stomach pain, nausea, bloody stool, diarrhea, constipation, or infection. Symptoms are dependent on what the person ingests. For example, someone eating paint chips that contain lead may show signs of lead poisoning. Hard objects, like rocks, can cause intestinal blockages or chipped or damaged teeth.
Caregivers can learn what to look for to determine if their child or someone in their care has pica. The objects ingested by people with pica vary but can include gum, metal, paint, charcoal, soap, cloth, hair, paper, string, and chalk. To be pica, eating these items must be developmentally inappropriate. For example, children under two commonly put things in their mouths and eat things they find as they explore the world, but this is normal for their age and the action itself shouldn't cause worry (though the item ingested could).
To diagnose pica, the doctor looks at symptoms. If the person or child is high-risk, the doctor collects information about how long they have been eating nonfood items. If the behavior has gone on for more than a month, the doctor may diagnose pica. Although the doctor will likely perform one, in most cases, a physical exam will reveal nothing abnormal, unless there are complications.
When a doctor diagnosis pica, some lab work is done to evaluate for complications and toxicity. The physician will generally review lead, zinc, and iron levels, especially in children and pregnant women. In some cases, the doctor may order imaging. Abdominal x-rays, endoscopies, and barium studies can determine if there is a blockage in the intestines and ensure that any large objects pass safely.
Unfortunately, there is no way to prevent pica. As researchers have not determined a direct cause, there is no sure-fire preventative measures. Good nutrition may help some children avoid it, and close supervision can prevent complications from whatever is consumed. Parents with children who have been diagnosed can help prevent issues by watching children with pica carefully and removing dangerous substances from the home.
The primary treatment for pica is preventing the person from ingesting anything dangerous. Caregivers should reduce access to the substances the person craves and provide nutritional supplements when needed. In people with mental disabilities, aversion or behavior therapy may be successful. There are no specific pharmacological treatments.
Pica is usually short-term. In children and pregnant women, the behavior often disappears spontaneously. Those with intellectual impairment may have pica that persists for an extended time, making them more likely to experience side effects. Complications depend on the substances the person ingests. For example, eating clay leads to constipation and can cause bowel obstructions. Ingesting ice is linked to iron deficiency. Paint and other coatings may contain a range of toxic materials. People with pica are also at high risk for lead poisoning, which can result in seizures, memory problems, mood disorders, and miscarriage or stillbirth in pregnant women.
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