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Pica

Definition

Pica is an eating disorder in which a person repeatedly eats non-food items.

What is going on in the body?

Someone with pica may eat clay, dirt, metal, paper, animal feces, paint, ice or hair. This disorder is most common in children, persons with mental retardation, and pregnant women. Teenagers with iron deficiency may eat ice.
Pica may occur for no known reason.

Risks

What are the causes and risks of the condition?

The exact cause of pica is often unknown. It is considered normal for children younger than 18 to 24 months old to put things in their mouths. After this age, eating non-food items is considered to be abnormal.
Some people are more likely to have pica:
  • children older than 24 months
  • pregnant women, especially in rural areas
  • persons with mental retardation
  • people with severe psychological problems
  • people with zinc or iron deficiency

Prevention

What can be done to prevent the condition?

Most cases of pica cannot be prevented. Eating a well-balanced diet following the Food Guide Pyramid (see www.choosemyplate.gov) can prevent some cases due to zinc or iron deficiency.

Diagnosed

How is the condition diagnosed?

There is no test that can diagnose pica. The diagnosis is made when there is a history of eating non-food items for more than one month. The healthcare professional will often order blood tests to rule out iron or zinc deficiency. These tests may include a serum iron level, a zinc level, and a complete blood count (CBC) to measure the number of blood cells, which could be low due to iron deficiency.

Long Term Effects

What are the long-term effects of the condition?

Pica in children often goes away by the teenage years. Pregnant women usually stop having pica after delivery. The disorder may be permanent in someone with mental retardation or severe psychological problems. Other long-term effects are related to the substance eaten. For example, eating chips of lead paint may cause permanent brain damage from lead poisoning. Eating other toxic substances can result in poisoning and death.

Other Risks

What are the risks to others?

Pica is not contagious and poses no risk to others.

Treatments

What are the treatments for the condition?

Treatment is directed at the cause of the pica, if known. For example, those with iron or zinc deficiency are given mineral supplements to correct the problem. Pregnant women and children are often given counseling. Children are observed to see if they "grow out of it."
In those who continue to eat non-food items, behavior therapy can be tried. This often involves punishing the bad behavior with a mild shock, a loud noise, or a medication that causes vomiting. Another type of behavioral therapy is rewarding good behavior. For example, a child may be given some kind of small reward each night he or she has avoided eating non-food items. Increased attention from parents can also help some children. Counseling is often useful.

Side Effects

What are the side effects of the treatments?

There are few side effects to these treatments for pica. Iron supplements can cause constipation or other gastrointestinal side effects. Counseling may bring up issues that upset the person. This can sometimes worsen the behavior for a short period of time.

After Treatment

What happens after treatment for the condition?

As mentioned, most children and pregnant women "grow out of" this condition and need no further treatment. Those with zinc or iron deficiency often get better when these problems are fixed.
In individuals with mental retardation or psychological problems, treatment is often less effective. These individuals may need close monitoring to make sure they do not eat harmful materials. Those who do eat harmful items may need monitoring and treatment for the effects these items have on the body.

Monitor

How is the condition monitored?

Parents or other caregivers can help monitor the affected person at home. Behavior therapies usually require the caregiver to give punishments or rewards when certain behaviors occur. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Synopsis of Psychiatry, Kaplan et al, 1998

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