Straight, No Chaser: Go Eat Rocks? Discussing Pica

pica

What the what? Pica is a pattern of eating non-food materials. This pattern must be present for at least a month to make the diagnosis. Pica is not a single incidence of a foreign body ingestion. It is not the activity of infants exploring their universe. It is an intentional and repeated effort to consume certain substances not associated with human nutrition.

Who does this?

  • Pica can be seen in any age group, although it is more frequently seen in younger children.
  • Estimates suggest that up to a third of children below age six engage in this activity.
  • Pica is also seen disproportionately during pregnancy.

Why would anyone do this?

Some individuals can’t overcome cravings or the desire to feel a certain texture in their mouth. These cravings may result from nutritional deficiencies such as iron or zinc.

What type of things are people with pica eating?

Common substances include the following:

  • Clay or dirt
  • Feces
  • Hairballs
  • Ice
  • Paint or paint chips
  • Rocks
  • Sand

What’s done about this?

The approach should include three considerations: addressing the underlying cause, addressing the consequences of the ingestion and eliminating the desire to continue the activity.

  • Addressing the underlying cause: When pica occurs in malnourished individuals, iron and/or zinc replacement (preferably through improving regular nutrition) is important.
  • Addressing the consequences of the ingestion: Lead poisoning may occur if certain types of paint/paint chips are ingested. Infection may occur if soil, feces or other contaminants are eaten. These are serious considerations and must be addressed.
  • Elimination of the desire to continue the activity: Family education, proper nutrition, positive reinforcement for good behaviors and negative reinforcement (such as aversion therapy) for destructive behaviors are possible components of therapy. Additional medications to modify behavior may also be needed.

What happens as a result of this?

It stands to reason that either a positive or negative outcome could occur. The disorder can disappear on its own, particularly if it’s simply associated with nutritional deficiencies that are addressed.

Pica can be long-lasting and destructive if associated with developmental disorders and undiscovered. It may also be especially dangerous if the substance ingested is toxic (e.g., lead poisoning via paint chips). In these instances it may be discovered as part of an illness presenting and resulting from the abnormal ingestions.

Complications can include infection, intestinal obstruction, lead poisoning, malnutrition and a mass of indigestible material can become trapped in the stomach or intestines (known as a bezoar) The appearance of a hairball is shown on the X-ray below.

bezoar

What am I supposed to do about this?

That should be the easy part. If and when you notice anyone ingesting something abnormal on just one occasion, you should seek medical attention.

Feel free to ask your SMA expert consultant any questions you have on this topic.

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