Pica - Causes, Symptoms and Treatment

Pica is an eating disorder. It is much more common in developing countries and rural areas. Pica is seen more in young children than adults, with 10-32% of children aged 1 to 6 exhibiting these behaviors. Pica can occur during pregnancy. 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). Pica is a serious behavioral problem because it can result in significant medical sequelae. The nature and amount of the ingested substance determine the medical sequelae. Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning. The ingestion of bizarre or unusual substances also has resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (ingestion of burnt match heads). Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning . There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs ) to settle dust. Lead toxicity is the most common type of poisoning associated with pica. Lead has neurologic, hematologic, endocrine, cardiovascular, and renal effects. Lead encephalopathy is a potentially fatal complication of severe lead poisoning, presenting with headache, vomiting, seizures, coma, and respiratory arrest. Ingestion of high doses of lead can cause significant intellectual impairment and behavioral and learning problems

Pica is most common in people with developmental disabilities, including autism and mental retardation. Pica may also occur in adults who crave a certain texture in their mouth. The causes of pica of biochemical deficiency and more often iron deficiency. Iron deficiency (or "sideropenia") is the most common known form of nutritional deficiency, such as iron or zinc, that may trigger specific cravings. Cultural and familial factors- Clay or soil and the ingestion of starch may be culturally based and is regarded as acceptable by various social groups. Clay eating and starch eating are seen in the United States in some southern, rural, African American communities, primarily among women and children. Starch eating, in particular, is frequently started in pregnancy as a treatment of morning sickness and is seen most often in pregnant and postpartum females. Learned behavior-In individuals with mental retardation and developmental disabilities in particular, the traditional view is that the occurrence of pica is a learned behavior maintained by the consequences of that behavior. Maternal deprivation, parental separation, parental neglect, child abuse, and insufficient amounts of parent/child interactions have been associated with pica. Treatment options include: discrimination training between edible and nonedible items, self-protection devices that prohibit placement of objects in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief physical restraint, and overcorrection (correct the environment, or practice appropriate alternative responses).

Causes of Pica

common causes and risk factors of Pica

• Nutritional deficiencies.
• Cultural and familial factors.
• Stress.
• Low socioeconomic status
• Nondiscriminating oral behavior.
• Underlying biochemical disorder.

Signs and Symptoms of Pica

Sign and symptoms of Pica

• Nonnutritive substances for a period of at least 1 month.
• Nonnutritive substances is inappropriate to the developmental level.
• Culturally sanctioned practice.

Treatment of Pica

Common Treatment of Pica

• Treatment emphasizes psychosocial, environmental, and family guidance approaches.
• Other successful treatments include mild aversion therapy (associating the pica behavior with bad consequences or punishment) followed by positive reinforcement for appropriate eating.
• Medications may help reduce the abnormal eating behavior, if pica occurs in the course of a developmental disorder such as mental retardation or pervasive developmental disorder.