Pica help

[Guest guest]

Hi all,

I have a question about Pica. My daughter just turned 8 and she has been

putting non food items like soap and clothes in her mouth for few years now, my

question is has any parent seen this behaviour in their kids because i dont know

how to make her stop mouthing non food items for good. I haven't tested my

daughter if she is deficient in any vitamin or mineral for her to mouth non

edible stuff. My daughter is on GF/CF diet and her pica has been m some times

more and some times almost not there .I would appreciate any advice from parents

of might have helped their kids with Pica problem. Thank you in advance.

Uma

[Guest guest]

Definition

Pica is

the persistent craving and compulsive eating of nonfood substances. The

Diagnostic and Statistical Manual of Mental Disorders, fourth edition,

classifies it as a feeding and eating disorder of childhood.

Description

The

puzzling phenomenon of pica has been recognized and described since ancient

times. Pica has been observed in ethnic groups worldwide, in both primitive and

modernized cultures, in both sexes, and in all age groups. The word pica comes

from the Latin name for magpie, a bird known for its unusual and indiscriminate

eating habits. In addition to humans, pica has been observed in other animals,

including the chimpanzee.

Pica in

humans has many different subgroups, defined by the substance that is ingested.

Some of the most commonly described types of pica are eating earth, soil or

clay (geophagia), ice (pagophagia) and starch (amylophagia). However, pica

involving dozens of other substances, including cigarette butts and ashes,

hair, paint chips, and paper have also been reported. In one unusual case, the

patient ingested transdermal patches of fentanyl, an opioid medication given

for severe pain. Eating the skin patch increased the patient's dose of the drug

by a factor of 10.

Although

pica can occur in individuals of any background, a higher incidence of pica is

associated with:

pregnancy

developmental delay and mental retardation

psychiatric disease and autism

early childhood

poor nutrition or low blood levels of iron and

other minerals

certain cultural or religious traditions

Causes and symptoms

Evidence

suggests that there may be several causes of pica. One widely held theory

points to iron deficiency as a major cause of pica. Several reports have

described pica in individuals with documented iron deficiency, although there

has been uncertainty as to whether the iron deficiency was a cause of pica or a

result of it. Because some substances, such as clay, are believed to block the

absorption of iron into the bloodstream, it was thought that low blood levels

of iron could be the direct result of pica. However, some studies have shown

that pica cravings in individuals with iron deficiency stop once iron

supplements are given to correct the deficiency. Another study looked

specifically at the rate of iron absorption during pica conditions and normal

dietary behavior, and showed that the iron absorption was not decreased by

pica. In addition, low blood levels of iron commonly occur in pregnant women

and those with poor nutrition, two populations at higher risk for pica. Such

findings offer strong support of iron deficiency as a cause, rather than

result, of pica.

Other

reports suggest that pica may have a psychological basis and may even fall into

the spectrum of obsessive-compulsive disorder. Pica has a higher incidence in

populations with an underlying diagnosis involving mental functioning. These

diagnoses include psychiatric conditions like schizophrenia, developmental

disorders including autism, and conditions with mental retardation. These

conditions are not characterized by iron deficiency, which supports a

psychological component in the cause of pica.

Cultural

and religious traditions may also play a role in pica behavior. In some

cultures, nonfood substances are believed to have positive health or spiritual

effects. Among some African Americans in the south, ingesting a particular kind

of white clay is believed to promote health and reduce morning sickness during

pregnancy. Other cultures practice pica out of belief that eating a particular

substance may promote fertility or bring good luck.

The

hallmark feature of pica, consistently consuming nonfood substances, often does

not present publicly. People may be embarrassed to admit to these unusual

eating habits, and may hide it from their family and physician. In other cases,

an individual may not report the pica to a physician simply because of a lack

of knowledge of pica's potential medical significance.

Because

the eating behaviors of pica are not usually detected or reported, it is the

complications of the behavior that bring it to attention. Complications vary,

depending on the type of pica. Geophagia has potential side effects that most

commonly affect the intestine and bowel. Complications can include

constipation, cramping, pain, obstruction caused by formation of an

indigestible mass, perforation from sharp objects like rocks or gravel, and

contamination and infection from soil-dwelling parasites.

Amylophagia

usually involves the consumption of cornstarch and, less frequently, laundry

starch. The high caloric content of starch can cause excessive weight gain,

while at the same time leading to malnutrition, as starch contributes

" empty " calories lacking vitamins and minerals. Amylophagia during

pregnancy can mimic gestational diabetes in its presentation and even in its

potential harmful effects on the fetus.

Pica

involving the ingestion of substances such as lead-based paint or paper

containing mercury can cause symptoms of toxic poisoning. Compulsive

consumption of even a seemingly harmless substance like ice (pagophagia) can

have negative side effects, including decreased absorption of nutrients by the

gut.

Diagnosis

In order

for the diagnosis of pica to be made, there must be a history of persistent

consumption of a nonfood substance continuing for a minimum period of one

month. Infants and toddlers are typically excluded from this diagnosis since

mouthing objects is a normal developmental behavior at that age. Individuals

with mental retardation who function at or below an approximate cognitive level

of 18 months may also be exempt form this diagnosis.

Pica is

most often diagnosed when a report of such behaviors can be provided by the

patient or documented by another individual. In other cases, pica is diagnosed

after studies have been performed to assess the presenting symptoms. For

example, imaging studies ordered to assess severe gastrointestinal complaints

may reveal intestinal blockage with an opaque substance; such a finding is

suggestive of pica. Biopsy of intestinal contents can also reveal findings,

such as parasitic infection, consistent with pica. Pica may also be suspected

if abnormal levels of certain minerals or chemicals are detected in the blood.

Pica in

pregnant women is sometimes diagnosed after childbirth because of a health

problem in the newborn caused by the substance(s) ingested by the mother. In

one instance reported in Chicago,

a newborn girl was treated for lead poisoning caused by her mother's eating

fragments of lead-glazed pottery during pregnancy.

Treatment

Treatment

of pica will often depend on the cause and type of pica. Conventional medical

treatment may be appropriate in certain situations. For example,

supplementation with iron-containing vitamins has been shown to cause the

unusual cravings to subside in some iron-deficient patients.

Medical

complications and health threats, including high lead levels, bowel perforation

or intestinal obstruction, will require additional medical management, beyond

addressing the underlying issue of pica.

Alternative treatment

Because

most cases of pica do not have an

obvious medical cause, treatment with counseling, education, and nutritional

management is often more successful and more appropriate than treatment with

medication. Some therapists specializing in eating disorders may have expertise

in treating pica.

Prognosis

The

prognosis for individuals with pica varies greatly, according to the type and

amount of substance ingested, the extent of presenting side effects, and the

success of treatment. Many of the side effects and complications of pica can be

reversed once the behavior is stopped, while other complications, including

infection and bowel perforation, pose significant health threats and if not

successfully treated may result in death.

When seen

in children, pica behavior tends to lessen with age. However, individuals with

a history of pica are more likely to experience it again. Counseling and

nutritional education can reduce the risk of recurrence.

Prevention

There are

no known methods of preventing pica. However, once pica is known or suspected,

measures can be taken to reduce further ingestion of nonfood substances.

Removing the particular substance from readily accessible areas can be helpful.

Close observation of the individual with pica may limit inappropriate eating

behaviors.

Key Terms

Amylophagia

The compulsive eating of purified starch, typically

cornstarch or laundry starch.

Geophagia

The compulsive eating of earthy substances, including

sand, soil, and clay.

Pagophagia

The compulsive eating of ice.

For Your Information

Resources

Books

American Psychiatric Association.Diagnostic and

Statistical Manual of Mental Disorders. 4th ed, revised. Washington, DC:

American Psychiatric Association, 2000.

Beers, Mark H., MD, and Berkow, MD.,

editors. " Anemias. " In The Merck Manual of Diagnosis and Therapy.

Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Beers, Mark H., MD, and Berkow, MD.,

editors. " Malnutrition. " Section 1, Chapter 2 In The Merck

Manual of Diagnosis and Therapy. Whitehouse

Station, NJ:

Merck Research Laboratories, 2002.

Periodicals

,

W. Clay. " Amylophagia Presenting as Gestational Diabetes. "

Archives of Family Medicine 9 (July 2000): 649-652.

Kirschner, . " Management of Pica: A

Medical Enigma. " American Family Physician 63, no. 6 (March 15,

2001): 1169.

Liappas, I. A., N. P. Dimopoulos, E. Mellos, et

al. " Oral Transmucosal Abuse of Transdermal Fentanyl. " Journal

of Psychopharmacology 18 (June 2004): 277-280.

Moya, J., C. F. Bearer, and R. A. Etzel.

" Children's Behavior and Physiology and How It Affects Exposure to

Environmental Contaminants. " Pediatrics 113 (April 2004): 996-1006.

Mycyk, M. B., and J. B. Leikin. " Combined

Exchange Transfusion and Chelation Therapy for Neonatal Lead

Poisoning. " ls of Pharmacotherapy 38 (May 2004): 821-824.

Organizations

American

Academy of Child and

Adolescent Psychiatry. 3615

Wisconsin Avenue, NW, Washington,

DC 20016-3007.

. Fax: .

Other

" Pica: Dirt Eating or 'Geophagy'. "

Support, Concern and Resources For Eating Disorders, 2000.

" Pica. " KidsHealth. The Nemours

Foundation, 2001.

Gale Encyclopedia of Medicine, Published

December, 2002 by the Gale Group The

Essay Author is Stefanie B. N. Dugan, M.S..

This article was updated on 08-14-2006

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