By Drs. Sally Robinson and Keith Bly

Most children put non-food items in their mouths at some point. For example, a child may put dirt from a sandbox in her mouth. This is a normal exploration of their environment. However, some children may develop pica, an eating disorder characterized by persistent and compulsive cravings to eat items other than food. The word “pica” comes from the Latin word for magpie, a bird known to eat almost anything.

Pica is most common in children between age 2 and 3, and in those with developmental disabilities, such as autism and mental retardation. Children with pica may crave and eat non-food items such as dirt, clay, paint chips, plaster, chalk, cornstarch, baking soda, coffee grounds, cigarette ashes, cigarette butts, feces, glue, hair, buttons, paper, sand, toothpaste and soap. Children with pica may repetitively eat such items for a period of one month or longer. Some of these items may seem harmless, but pica is a serious eating disorder and can lead to health problems such as worm or parasite infections, lead poisoning, intestinal obstruction and iron-deficiency anemia.

The causes of pica are unknown, but some situations that increase the risk of pica include:

• Mineral deficiencies
• Malnutrition
• Cultural factors
• Parental neglect, lack of supervision, or food deprivation
• Developmental problems
• Mental health conditions
• Pregnancy

If you suspect your child may have pica, talk to your pediatrician, who may test your child for iron or zinc deficiencies, as well as lead poisoning. Iron is used by the body to make hemoglobin (the red part of your blood that carries oxygen throughout the body), by the nervous system for growth and to fight infections. Foods that contain iron include meat, eggs, grains, cereal, dried fruits (apricots, prunes and raisins), green leafy vegetables (such as spinach, greens and broccoli) and legumes (beans and nuts). The body uses zinc for growth, vision, taste and smell. Zinc also helps wounds to heal and fight infections. It is found in meat, seafood, eggs and dairy products.

Your doctor will also educate you on how to manage and prevent pica-related behavior, by suggesting ways to teach your child about acceptable and unacceptable food items. If your child’s iron and zinc levels are normal, your doctor may suggest a child psychologist for behavioral therapy.

Pica is normally a temporary condition that improves as your child gets older, but it may be more difficult to control pica in children with developmental or mental health issues.

If your child’s pica behavior does not improve after several weeks after treatment, call your pediatrician. Being patient with your child is important in treating pica – remember to praise your child when you notice that he has not been eating non-food items.

Dr. Sally Robinson is a pediatrician in the division of children’s special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB.
The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email jskoloen@utmb.edu.

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