Pica Disorder

Baby with paint brush in his mouth, indicating Pica disorder

What to do when your child eats non-foods. It is common for very young children, under the age of 18 months, to put a range of things (other than food) in their mouths as they learn about their surroundings. But at what age and stage does this become an issue?

what is pica?

After the age of about 18 months, repeatedly eating items which are considered ‘non-nutritive’ (ie, not food) after that age is generally considered abnormal. These non-foods can include dirt, clothing, toothpaste, paper, hair, glass, string, paint, stones … the list goes on. It seems to depend primarily on how mobile the child is as to what items they can access.

The word ‘pica’ is defined differently depending on where you look but the DSM-IV* calls for “persistent eating of non-nutritive substances for at least one month that is developmentally inappropriate, not culturally sanctioned and severe enough to warrant clinical attention.” (This definition therefore excludes some cultural practices such as the eating of soil or clay in various parts of the world.)

how common is pica?

Because of the inconsistencies in the definition and due to the general under-reporting of these things, it’s difficult to know how prevalent pica is among children. That said, figures of between 10-30% of young children are often quoted. It seems to be most common amongst 2 to 3-year-olds, with the incidence reducing as they get older. It also seems to be much more often seen among children with an intellectual disability or autistic spectrum disorder. Girls and boys are affected equally.

why does it happen?

Researchers haven’t found the answer to this yet and, as is often the case, it’s likely that pica occurs in different children for different reasons. Some children with pica are found to have low iron and/or zinc levels. There has also been a suggestion that pica might be a compulsion for some children, like those seen in Obsessive Compulsive Disorder (OCD). Some other kids seem simply to like the sensation of different objects and textures in their mouths.

is pica dangerous?

This will depend on what the child is ingesting. Worrying non-foods include faeces or soil which might expose the child to parasitic infections; lead-based paint; and gravel or stones which might damage the child’s teeth or cause intestinal blockages.

what to do?

Even though pica in children with normal intelligence usually resolves without treatment by the time they’re teenagers, all kids with pica should be reviewed by their General Practitioner.

  1. What your GP will do: Your doctor will want to consider what is causing the pica for your child and look for any evidence of harm caused. Your doctor might also ask questions about what access your child has to dangerous items and about signs of autism and intellectual impairment, given that these conditions sometimes occur together. Your child might need a blood test to check for mineral deficiencies. Depending on the duration and severity of your child’s pica, your doctor may suggest a referral to a paediatrician, child psychiatrist or psychologist.
  2. What you can do: Learn about pica and try to prevent your child’s exposure to unsafe items. Consider locking up things such as cleaning liquids, paint, bleach, etc. For those children who appear to seek the sensation of different textures in their mouths, popcorn can be a useful alternative. If no other cause for your child’s pica is found, try to notice whether there are triggers for your child’s pica behaviour and talk to your GP about whether behavioural strategies might
    be helpful.

*American Psychiatric Association.
DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. American Psychiatric Press; 2000:103-105.

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