“I’ve always had weird eating habits. I craved and ate mud, talcum powder and chalk as a baby. I remember eating toothpaste, soap, chalky paint (the walls in my mom’s office were the unfortunate victim), charcoal, wool, and garden soil until my early teens. I did grow out of most of them in time but the talcum powder, which I started eating again during my pregnancy!
I understand that this isn’t a “Me-too” thing, but dear doctor, please treat us both!”
(A troubled mother of a toddler, who visited my clinic a couple of months back for a solution to her son savoring sand and garden soil, revealed her own helplessness at the temptation.)
Pica
The term “pica” is Latin for the word “Magpie” which is a bird known for its unusual and indiscriminate eating behaviors.
Pica is an eating disorder in which people have unusual cravings and actually ingest substances that are largely inedible and have no nutritional value such as dirt, clay, paper, soap, flaking paint, nails, etc. Other less common items may include glue, hair, cigarette buts, ashes, or even feces.
It can occur in children, adolescents and adults alike. While babies may explore the taste of non-food items and tend to put many a things into their mouth till they are about 18-24 months (a naturally inquisitive normal developmental tendency, they eventually would outgrow with time and age) and usually no harm is done, however, in a kid with Pica, this curiosity would lead to a compulsion to ingest these inedible items.
Such kinds of stuff are known to house bountiful of harmful bacteria, viruses, worms, and other parasites, but no matter how hard you try to explain, the warning will fall on deaf ears. A child with pica may start putting things in the mouth when no one is looking. You are worried to the core about toxins and bacteria affecting your kid, whilst your child relishes the taste.
Pica disorder can vary in the severity of items craved!
Ranging from ice (pagophagia); hair, wool, and other fibers (trichophagia); wood or it’s derivates such as glue, paper, toilet roll, cigarette buts, coal (xylophagia); starch from raw potatoes or rice (amylophagia); drywall or paint; chalk; ash, dirt, soil, clay (geophagia); dust (coniophagia); lead (plumbophagia); mucus or boogers (mucophagia) to sharp objects (acuphagia); metal (metallophagia); stones (lithophagia); glass (hyalophagia); feces (coprophagia); urine (urophagia); emetophagia (vomit) or hematophagia (Vampirism) (blood) amongst others.
What causes pica?
Pica can be a sign of a developmental, behavioral, cultural, nutritional or mental health issue.
It is estimated that 10% to 30% of kids ages one through six are likely to develop this eating disorder. On a few occasions, pregnant women too can crave strange, non-food items. This could be due to –
- mineral deficiency – calcium, iron or zinc (celiac disease or hookworm can sometimes cause this as well)
- malnutrition
- an acquired taste for the item
- intellectual and developmental disability – autism, mental retardation, obsessive-compulsive disorder, or childhood schizophrenia
- brain injury
- attention-seeking behavior
- maternal deprivation, poverty, or neglect
What can Pica do?
Pica symptoms depend entirely upon the nonfood item consumed.
Eating inedible stuff such as hair, sand, stones or bird dropping may lead to gastrointestinal problems. There is an increased risk of such stuff causing intestinal blockage or perforation calling for a surgical emergency. Ingesting stones can, in addition, give tooth injuries. Nowadays, the soil is chemically contaminated, sprayed with insecticides and pesticides, loaded with bacteria even those from manure and sewage along with pet feces and worms. It may lead to parasitic infestations, various infections, and even food poisoning. Continuous ingestion may lead to constipation, abdominal pain, vomiting, loss of appetite and diarrhea.
Depending on the surroundings (proximity to factories), the soil may also contain heavy metals such as lead and arsenic. Lead is also found in paint and wood polishes commonly used in the household. Consuming large quantities of lead can damage the nervous system of young children. Arsenic can make kids more vulnerable to develop cancer. Eating dirt and sand can also lead to iron deficiency.
How is pica diagnosed?
A person with pica would repeatedly eat nonfood items, even if they make him/her sick. If you have done all you can to prevent pica and it is still a problem for your child, then it is time to seek a professional’s help. A quick diagnosis is imperative for timely intervention before it leads to more serious physical and emotional problems.
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) Criterion for Pica
Eating of non-nutritive inedible substances:
- must persist for longer than one month
- at an age considered developmentally inappropriate
- must not be part of a culturally sanctioned practice
If the eating behavior occurs exclusively during the course of a mental disorder (e.g., intellectual disability, pervasive developmental disorder, schizophrenia), it is sufficiently severe to warrant independent clinical attention.
To get to the cause or to ascertain the resultant harm done, your physician may advise for your child
a. blood tests to look for toxins like lead in blood and also check your child’s calcium, iron and zinc levels.
b. X-ray to identify what was eaten and detect blockages in the intestines if any.
c. urine and stool test.
Treatment for Pica
Treatment for pica will address several areas viz. your child’s illness from having eaten nonfood items such as constipation, diarrhea, ulcer, intestinal tear, infection, or any combination of illnesses. If your child doesn’t have enough iron, calcium or zinc levels, vitamin supplements and dietary recommendations would be necessary.
Another focus of treatment will address the underlying cause of your child’s pica diagnosis. Your physician will discuss your child’s home environment, educate you as a parent, and refer your child to a behavioral or mental health specialist if needed.
Homoeopathy helps
It works not only upon the symptoms caused by the ingestion of nonfood items but also helps to correct the basic cause of pica. The Homoeopathic chest is full of a number of medicines that take care of this behavioral tendency and prevent its recurrence. There are specific medicines for specific cravings that hit the tendency right away.
Alumina – Unnatural craving for dry non-food items like charcoal, chalk or tea-grounds with an aversion to meat and disagreement of potatoes.
Bryonia – For a general disgust for food, however a great desire for wine and drinks that are acidic, coffee, and indigestible substances.
Calcium Carbonicum – Bitter, metallic taste with no appetite. Craving chalk, coal, pencils, eggs, sweets & wine. Aversion to boiled stuff. Milk disagrees inducing nausea and acid regurgitation.
Calcium Phosphoricum – Desire for lime, slate, pencils, earth, chalk, clay, etc. with weak digestion.
Cicuta Virosa – Craves unnatural foods, particularly coal. Worm infestations.
Lac Felinum – Craves eating paper with little appetite & bloating after eating.
Nitricum Acidum – Craving for chalk, earth, lime, and other indigestible substances, fatty foods and herring. Nausea. Cannot digest milk.
Nux vomica – Desires stimulants, fatty foods, and chalk.
Silicea – Perfect for obstinate and headstrong kids with delayed milestones who crave lime, sand, raw foods.
Pica Prevention Tips
To ensure safe play in dirt/mud and catch the disorder at the start before any complications happen, please do the following:
- Teach your children what is and is not safe to eat.
- Pay close attention to your child’s eating habits and explain the consequence of eating non-food items.
- Keep away pencil, eraser, crayons, paper, coins, and such other small items from your kid.
- Make sure there are no chipped paints within the range of your kid.
- If you have potted plants, perch them high up on the wall, away from your child’s reach.
- Throw away pebbles, pet poop, stray leaves from your verandah and backyard. Eliminating the objects from the vicinity of the child to prevent him from coming across them is a smart move.
- If you have a garden, consider fencing it with a gate and make sure you are around your kid whilst he plays outside.
- It’s best to supervise or play with your kids in the garden or if you have a separate sand play area. Infants can get choked by gritty sand.
- Keep pet food away from your child’s reach, it has been known to cause salmonella infections.
- Encourage your kids to wash their hands and mouth after playing with the dirt.
Give a balanced diet to your child with an increased proportion of calcium, iron, and zinc. These can be obtained from meat (esp. red meat), liver, eggs, seafood, grains, cereals, legumes, and dairy products. Your physician may prescribe supplements.
For some children, alleviating pica behaviors can be a relatively easy process, while for others it may take a professional working with your child through more advanced techniques. Most of them outgrow pica as they get older. However, high-risk populations, i.e. children and adults with intellectual or developmental disabilities may need continued monitoring of their behavior and environment.
In the end, there’s nothing to panic over. It’s just a developmental phase and a reminder that your kid needs your attention and love! It is important to remember to have patience with the process and continue to be positive. Always encourage your child, no matter which treatment route is taken.
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Dr Renu Madan 