What To Do About Pica - A Game Plan

The Game Plan is at the end of this article, if you need to cut to the chase.

Pica entails a history of pervasive and persistent ingestion of non-food substances for a least 30 days or more by someone older than a toddler physically and mentally. The sufferer may hide the condition because of embarrassment or to avoid being stopped from the non-food eating behaviors. Thus it can be difficult to discover and diagnose.

Infants and toddlers rarely receive a diagnosis of pica, since they are always putting things into their mouths in order to explore their world. I've noticed that kids and cats eat a lot of things just once, to see if it is good to eat or if anything interesting happens as a result.

Individuals having MR/DD conditions and syndromes that place them at the mental age of 18 months or younger also do not usually receive such a diagnosis as pica.

No test specifically for pica is available, but tests for lead in the bloodstream and for low iron content in blood can result in treatments that will stop pica in certain cases.

The diagnosis is based on self reports or reports of parents and significant others. In a clinical setting, diagnosis is made on observations of behaviors and of MRI related scans that may reveal intestinal blockages formed by inedible materials. Intestinal biopsy usually follows to confirm. Blood tests, however, may reveal an abnormally high concentration level of particular chemicals or minerals and lead eventually to a diagnosis of pica. There are no direct tests for pica.

Pica is a puzzle after decades of examination. I first heard of it in public health classes, presented and discussed by social workers that were working to remove lead-based paints from inner city buildings, because poor children were eating paint chips and suffering lead poisoning. The same children ate paper because there was no food in the house.

In parts of Russia during World War II, people of all ages during the Hungry Winter were starved out by the Nazis and ate their zoo animals and pets, cooked pages and bindings of books, cooked leather garments and tree bark; then resorted to cannibalism.

This does not explain the occurrence of pica in ancient times. Pica has always affected every type of personage of any stripe. Pica (Latin for magpie) affects humans, magpies (Mynah birds), and chimpanzees, among a few others.

Goats do eat paper form time to time, but not tin cans, as has been a myth for many years. Some cats play with paper and then eat it for fun; too much and they gain an intestinal blockage.

Pica in humans is multivariate, graduated by type of object ingested:

• Geophagia - Eating earth, soil or clay (geo = earth, phagia relates to eating),
• Pagophagia - Ice -- Many among us have eaten ice, but some do it compulsively.
• Amylophagia - Laundry starch and corn starch.
• Other-phagias: Cigarette butts, ashes, hair, feces, paint chips, plaster chips, chalk, crayons, pencil erasers, paper, foam rubber (sometimes an indicator of Sickle Cell anemia, but not always). There is even one about compulsive eating of potatoes-only.

Recent research connects pica more often with the following conditions than among the general population:

• During Pregnancy
• In cases of MR/DD - Developmental delay and mental retardation
• During pychiatric diseases like autism spectrum disorders
• During infancy and toddler years - It's still a problem if these children eat lead paint and poisonous substances.
• Possibility: in those with in adequate nutrition or low blood levels of iron and other minerals
• In cultures where folk medicine recommends ingesting a non-food sbstance such as certain clay, tree barks, etc.

• Iron Deficiency - The Chicken or the Egg?

Iron deficiency may or may not cause pica and pica may be responsible for some cases of iron deficiency, especially in pregnant women.. It is best to see a doctor about this question.

• Psychiatric Disorders?

Pica may be a manifestation of psychiatric disorders.A few of them are obsessive-compulsive disorder, reduced cognitive functioning, schizophrenia, MR/DD, autism spectrum disorders, and others. None of these disorders exhibit iron deficiency in their symptomatology, suggesting pica is a psychiatric symptom.

Complications

• Pica has caused constipation (but his is aso a sign of sexual abuse in some children), intestinal cramps, pain, obstructions, inflammation, gastrointestinal perforation, and infection produced by ingested parasites.
• MALNUTRITION - Amylophagia can cause weight gain in the presence of malnutrition, a confounding phenomenon - the starch provides calories without nutrients. Amylophagia during pregnancy can look like gestational diabetes and must be considered in the differential diagnosis. Compulsive ice eating can decrease the absorption of nutrients by stomach and intestines and cause malnutrition.
• Eating lead-based paint or mercury-content paper can result in poisoning.

Questions to ask yourself or your loved one:

1. Is the person pregnant?
2. Is the person under 4 or 5 years old?
3. Is the person receiving adequate nutrition?
4. Is the person of at least average intelligence and average or better development associated with chronological age?
5. Does the person have a written psychiatric diagnosis from a board-certified psychiatrist or psychologist (Do not ever guess or accept a "cocktail-party diagnosis" or "back fence opinion"; consult a psychiatrist or at least an MD or DO.)
6. Is the person observing a folk medicine or religious treatment for some condition that involves what looks like pica but may or may not be pica?
7. Does the person have an iron deficiency?

8. Does the person have Sickle Cell anemia?

Take your answers and consult a physician.

Steps to take with a CHILD exhibiting pica

Consult a physician for physical examination; specifically iron deficiency and Sickle Cell; and malnutrition - even a child that eats well may have malnutrition, because nutrients are not absorbed as a result of some physical problem.If your child possesses an MR/DD diagnosis already, ask the doctor if it is connected with the specific brand of pica you see,

If physical tests are negative, then

Consult a psychiatrist for psychiatric evaluation. Once a condition is found and treatment begins to succeed, pica often fades away. Talking or conditioning therapies may be necessary, or medications may be required (a psychiatrist administers these, not a psychologist).

If psych tests are negative, then

Find out if someone in the household is "making' the child eat non-food items, especially if the child is very young. This can be by force to be cruel or by persuasion to be entertained (either is abusive). If you find the culprit, take appropriate action.

If no one is influencing the child to commit pica, then we are nearly out of answers.

• Lock up the non-food items your child eats. If these include paper, crayons, etc, allow the child to use them only under your supervision and alert the preschool or school that supervision must be the case at school as well. This is tedious, but you want answers and a conclusion to the problem and you must persist more strongly than does the pica.
• This condition, if not a part of usual toddler put-in-the-mouth behavior can be as cunning as alcohol and drugs, and perhaps is an addiction in certain cases -- Your doctor can help you decide and offer you treatment alternatives.
• If a child is eating non-food items in order to disturb or control adults, like parents, then you have a discipline and control problem. Hopefully, it is righted with medical/counseling/pastoral guidance before the child must undergo painful abdominal surgery to remove accumulated wads of indigestible goods.