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Peculiar PICA

The word “pica” comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite of ingesting random items.

It is a delight to watch one’s children grow up . However, during growing years, it’s common to see some children eat substances that have no nutritional value and cannot be typically classified typically as “food” items. These substances may be  clay, soil , paint, soap, chalk , toothpaste, cigarette butts, ash, mud, talcum powder, metals and  paper. This craving  and consuming such substances is an eating disorder called PICA. The word “pica” comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite of ingesting random items. While Anorexia and Bulimia are commonly known eating disorders, not much is known in general about Pica. The pica is usually a manifestation of an underlying medical condition, most often iron deficiency anemia.

It is most common in children under 2 years of age. Did you know Pica occurs in about 25-33% of young children.  Children  with developmental disabilities, like autism & intellectual disabilities and adults( suffering from mental illnesses like epilepsy, schizophrenia, autism)may also have Pica and sometimes even pregnant women also crave and eat these non-food substances. Worldwide, about 20% of Pica cases involve pregnant women.  Amongst individuals with cognitive impairments, Pica most commonly occurs in people between the ages of 10-20 years.

There are no lab tests to diagnose Pica, and only a patient’s clinical history can help determine it. Diagnosing Pica should be accompanied with tests for anemia, potential intestinal blockages and side effects of toxic substances consumed and an x-ray too, if the child is into ingesting metals.

Symptoms of PICA include :

- Consuming these non-food substances persistently over a month by children above the age of 2 years. Below 2 years of age, it is considered developmentally normal to put things in mouth and sometimes ingest them.

- No other family members(adults) consume that substance as part of any cultural practice.

Causes of Pica could be many, ranging from pregnancy to nutritional deficiencies, malnutrition, cultural factors, developmental issues, mental health conditions, parental neglect and lack of supervision.  Some adults who had Pica during childhood may continue to eat the non-food substances as they may associate that with a  childhood trauma.

Medical complications resulting from Pica may include tear in esophagus, intestinal blockages, constipation, pica anemia, lead poisoning, gastric pain and dysbiosis.

Most common nutritional deficiencies that trigger cravings for non-food substances are of zinc and iron. However, this does not imply that the craved and consumed non-food items are sources of these 2 minerals.  Hence, the first line of treatment would include checking for nutritional deficiencies and fixing them with appropriate nutrition therapy. Most children respond positively  to this and Pica and be greatly reduced within days. Foods like beans and lentils, green leafy vegetables, garden cress seeds, organ meats, eggs, dry fruit are good sources of iron for children. They should be eaten by the entire family so that it is inculcated as a habit in children too. Dietary sources of zinc include nuts, seeds, dairy, eggs, whole grains.

Treat of Pica should be individual-centric and based on the specific cause. Parental education is a crucial element in development as well as prevention of Pica. Poor parents of malnutritioned children often fail to identify Pica as abnormal behavior. Managing the patient’s environment is an effective part of the treatment by keeping the “non-food” items out of reach.  Sometimes, the treatment may also include medication and behavioral intervention.

Pica can be classified as an addiction and may re-occur after treatment in rare cases. Hence, it is important for these individuals to ensure a well-balanced diet and stay away from any kind of substance abuse, as they are more prone to it.

Fortunately , Pica improves as the child grows older. Though it may persist in people with developmental or mental health concerns.


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PICA Mansi Chaudhary

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