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What you need to know about Pica

No one wants to know what pica is. But in the disability community, pica may come looking for you.  And if pica knocks on your door, you’re going to need some answers. If you’re squeamish, stop reading now.

What is Pica?

Pica is the urge to eat non-foods such as sand, clay, ice, hair, cloth, starch, chalk, stones, dust, glass, paint, wood, paper, mucus, urine or feces. Pica-related behavior often occurs in children or pregnant women due to nutrient deficiencies, especially a lack of iron, zinc or other minerals in the diet.  Pagophagia, the pathological consumption of ice, is typically associated with anemia. In many cultures around the world, some types of pica are part of religious or healing rituals, and are considered appropriate within that context.  In children under the age of 2, occasional sampling of non-foods is a normal part of sensory development, but pica is a dangerous behavior of persistent cravings that continues longer than 1 month.

Causes of Pica

Pica is most common in people with developmental disabilities, brain injury, seizure disorders, obsessive-compulsive disorder and schizophrenia.  According to the National Autism Center, these conditions are all possible causes of pica.

Complications from Pica

Pica is dangerous because it can lead to:

• Dental injury from eating hard or abrasive items
• Intestinal blockages or abdominal pain
• Internal injuries requiring emergency surgery
• Parasitic infections from eating dirt or feces
• Lead poisoning from eating paint chips or roadside dirt

How pica found me

I was walking my son to preschool one day, and I saw some students from the autism classroom on the playground.  We passed one student next to the sidewalk who was happily eating handfuls of sand mixed with wood chips and licking sand off the playground toys. The teachers were standing 20 feet away with their backs turned to the student.  As I passed the teachers, I told them that the child was eating sand.  One teacher smiled at me and said simply, “Yes.”  But she did not go to assist the student. I understood that the teachers were using the behavioral method of ignoring the child so that their attention would not be perceived as a reward for eating sand.  However, I also knew that this is not a recommended method for handling pica in a school setting, because it is foremost a safety issue.

Medical Treatment

It is important to consult with a physician about pica before attempting treatment.  The physician will probably test for lead poisoning or other types of poisoning.  In addition, there will be tests for nutrient deficiencies, and vitamins may be prescribed. I found one family that had success in treating pica with an over-the-counter drinkable vitamin.  A physician may also order an ultrasound or x-rays of the abdomen in case there are blockages or foreign objects in the digestive tract. In some cases in which pica is associated with a developmental disorder, a physician may prescribe medication.  Because there are so many types of pica and so many possible causes, physicians must treat each case separately.

Aversion Therapy

Pica-related behaviors can escalate quickly.  I know of one child at my son’s school - not the same child I saw on the playground - who will hide non-food items and save them to eat in secret later. A good place to start is with locks for cabinets at home.  Then a behavior plan needs to be created with the goal of reducing or eliminating pica. Mild forms of aversion therapy are usually recommended by psychologists for unsafe behaviors such as pica.  At the May Institute in Massachusetts, teachers developed a plan in which a child eating a non-food was interrupted and prompted to throw away the object 10 times following each incident.  This is known as “contingent practice” or “contingent exercise” in psychology.  A variation on this would be to interrupt the child and require that he wash sand or dirt off his face, and to close the sandbox every time an incident occurs. The hard part is the fact that constant supervision is required to prevent hoarding of non-food items.  A positive reinforcement for eating nutritious foods may make the behavior plan even more effective.  The reward can be music, dancing or another preferred activity not related to food.

Communication

Although my son is mainstreamed in general education now, I still know a few of the parents in the autism program at his school, so I contacted them to tell them what I saw on the playground.  Between 10% and 30% of children under age 6 have some form of pica. I think that parents, medical professionals and educational professionals should communicate openly with each other about pica to ensure the safety of our children.  If you know of other successful treatments for pica, please share them in the comments below.