FEEDING AND EATING Provided by

Your Local
DISORDERS OF INFANCY Public Health
A gency and the
Child Care
OR EARLY CHILDHOOD: Health
Consultation
Program
PICA
OVERVIEW:
DEFINITION
PREVALENCE
COMMON ITEMS
INGESTED
 WHAT IS PICA?

Children persistently eat one of more non-food

substances over the course of at least one
month
Considered a behavioral problem—self-
injurious
Theoretical causes include anemia, zinc
deficiency, mental retardation, developmental
delays, or family history
Other theories are oral fixation, lack of
appropriate stimulation, lack of attention
Causes are not definitively known
 WHAT IS PICA?

 More common among children and adolescents with other

developmental disabilities (Autism, Mental Retardation), or
children who have suffered a brain injury affecting their
development

 Also more common among children between age 2 and 3

 As many as 15% of adults with severe Mental Retardation

also have PICA

 Information on overall prevalence rates is limited

 WHAT IS PICA?

Specific causes are unknown, but certain

situations increase risk:
 Nutritional deficiencies
 Extreme dieting
 Malnutrition
 Cultural factors – certain religious rituals, folk
medicine, or magical beliefs
 Neglect/food depravation
 Mental health conditions
COMMONLY INGESTED NON-FOOD ITEMS

 Dirt  Burnt match heads

 Clay  Cigarette butts
 Paint chips  Feces
 Plaster  Ice
 Chalk  Glue
 Cornstarch  Hair
 Laundry starch  Buttons
 Baking soda  Paper
 Coffee grounds  Sand
 Cigarette ashes  Toothpaste
 Soap
 COMMON NON-FOOD ITEMS INGESTED

Younger children: Older children

 Paint  Animal droppings
 Plaster  Sand
 String  Insects
 Hair  Leaves
 cloth  pebbles
COMMONLY INGESTED NON-FOOD ITEMS

Because of the potential serious

health effects of ingesting these
items, be aware if any are in your
environment!!
 EFFECTS:
HEALTH PROBLEMS
MEDICAL EMERGENCIES
 EFFECTS OF PICA

The potential for illness and even

death is great because of toxicity of
some of these items, or risk of
intestinal blockage, poisoning, or
parasitic infections. Malnutrition is
also a potential risk.
 EFFECTS OF PICA

Two very common conditions

associated with PICA are lead
poisoning (often a result of eating
earth substances that contain lead)
and iron deficiency anemia which
may actually be an underlying trigger
to PICA.
 EFFECTS OF PICA

Constipation, diarrhea, or intestinal

blockage or perforation can all result
from items ingested

Parasites or other infections can occur

Tooth or mouth injuries can occur

 MEDICAL EMERGENCIES

If a non food item ingested was

toxic, you should follow your
emergency medical procedures
Even small amounts of toxic
substances can cause death in
young children (nicotine in tobacco
products, soaps, laundry items)
DIAGNOSIS:
WARNING SIGNS
EDUCATION
 WARNING SIGNS

Eating of nonfood items for a period of at

least 1 month or longer (in spite of
efforts to restrict)
Behavior inappropriate for child’s age or
developmental stage
Behavior is not part of cultural, ethnic, or
religious practice
 DIAGNOSIS

No single theory explains what causes

PICA
Each case must be individually evaluated
by a Doctor
Thorough physical exam in needed
Thorough medical, psychological, and
developmental histories must be
gathered
 DIAGNOSIS

Food-related behaviors evaluated

Dietary assessment
Environmental factors (presence of the
non-food items)
Developmental assessment
TREATMENT
RESTRICTIONS
BEHAVIORAL
MEDICAL EVALUATION
 TREATMENT

Provide alternative ways for oral

stimulation (they like the taste/texture)
Education on acceptable and unacceptable
food items
Replace non-food items with healthy
nutritious food items
Restriction of non food items to prevent
access/remove items from home (safety
locks, high shelving, keep chemicals out of
reach)
 TREATMENT

Medical evaluation for nutritional

deficiencies
Lead screening
Parasitic screening
Imaging for bowel problems/obstructions
Behavioral intervention if needed
 SOURCES

 Nemours Foundation, www.kidshealth.org

 Feeding and Eating Disorders of Infancy or Early Childhood:

Pica, http://www.pvmhmr.org/37-childhood-mental-disorders-
and-illnesses/article/572 -feeding-and-eating-disorders-of-
infancy -or-early -childhood-pica Andrea Barkoukis, M.A .,
Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.