Pica is defined as persistent eating of non-nutritive substances. In many cases, pica is identified only when medical problems such as intestinal obstruction, intestinal infections, or poisonings arise. 3
• Pica appears to be more common among children and adolescents with autism spectrum disorder and intellectual disability; and appears to affect both sexes equally. However,
the prevalence of pica is unclear.
• In certain regions of the world and among certain cultures, such as the Australian aborigines, rates of pica in pregnant women are reportedly high. According to DSM-5, however, if such practices are culturally accepted, the diagnostic criteria for pica are not met.
• Numerous etiologies have been proposed . They include nutritional deficiencies (e.g., iron, zinc, and calcium), low socioeconomic factors (e.g., lead paint exposure), child abuse and neglect, family disorganization (e.g., poor supervision), mental disorder, learned behavior, underlying (but undetermined) biochemical disorder, and cultural and familial factors. 2
• Severe child maltreatment in the form of parental neglect and deprivation has been reported in some cases of pica. Lack of supervision, as well as adequate feeding of infants and toddlers may increase the risk of pica.
DIAGNOSIS AND CLINICAL FEATURES 2,3
• Pica is most often a transient disorder that typically lasts for several months and then remits. It can be benign or life-threatening, depending on the objects ingested. In infants, paint, plaster, string, hair and cloth are objects that may be ingested, whereas older toddlers and young children with pica may ingest dirt, animal faeces, small stones and paper. DSM-5 suggests a minimum age of 2 years when making a diagnosis of pica.
PATHOLOGY AND LABORATORY EXAMINATION 3
• No single laboratory test confirms or rules out a diagnosis of pica, but several laboratory tests are useful because pica has sometimes been associated with abnormal levels of lead. Levels of iron and zinc in serum should be determined and corrected if low.
DIFFERENTIAL DIAGNOSIS 3
• The differential diagnosis of pica includes avoidance of food, anorexia, or rarely iron and zinc deficiencies.
• Pica may occur in conjunction with failure to thrive and be comorbid with schizophrenia, autism spectrum disorder and Kleine-Levin syndrome.
• In psychosocial dwarfism, a dramatic but reversible endocrinological and behavioral form of failure to thrive, children often show bizarre behaviors, including ingesting toilet water, garbage, and other non-nutritive substances.
• Lead intoxication may be associated with pica.
• No definitive treatment exists for pica per se; most treatment is aimed at education and behavior modification.
• The first step is to investigate the specific situation whenever possible.
• An effort should be made to ameliorate any significant psychosocial stressors. When pica occurs in the context of child neglect or maltreatment, clearly those circumstances must be immediately corrected.
• Exposure to toxic substances, such as lead must be eliminated.
• When pica persists in the absence of any toxic manifestations, behavioral techniques like positive reinforcement, modelling, behavioral shaping and overcorrection treatment have been used. Increasing parental attention, stimulation and emotional nurturance may yield positive results.
• Pica may present as pseudo-chronic disease if the cause is deficiency of nutritional substances or exposure to toxic substances , if not corrected at a right time may land into a true chronic disease or may present as true chronic disease directly.
RELATED RUBRICS: 5,6
GENERALS – FOOD and DRINKS – earth – desire
alum. calc. cic. con. ferr. hep. hyos. ign. Nat-m. Nit-ac. Nux-v. oci. puls. Sep. sil. sulph. tarent.
GENERALS – FOOD and DRINKS – indigestible things – desire
abies-c. Alum. alumn. Aur. bell. bry. Calc. Calc-p. cic. con. Cycl. ferr. ign. lac-c. LACH. nat-m. Nit-ac. nux-v. petr-ra. positr. psor. SIL. sulph. Tarent.
GENERALS – FOOD and DRINKS – lime, slate pencils, earth, chalk, clay – desire
Alum. Alumn. ant-c. Calc. calc-p. chel. cic. ferr. ign. lac-f. nat-m. NIT-AC. Nux-v. oci. petr-ra. psor. Sil. sulph. tarent. tub.
GENERALS – FOOD and DRINKS – chalk – desire
ALUM. ant-c. calc. cic. con. ferr. hep. hyos. ign. Nat-m. nit-ac. Nux-v. oci. psor. Puls. Sep. sil. sulph. tarent.
GENERALS – FOOD and DRINKS – sand – desire
GENERALS – FOOD and DRINKS – paper – desire
GENERALS – FOOD and DRINKS – coal – desire
Alum. Calc. Cic. ham. ign. psor.
GENERALS – FOOD and DRINKS – soap – desire
GENERALS – FOOD and DRINKS – starchy / GENERALS – FOOD and DRINKS – farinaceous – desire
adam. aeth. aloe Alum. aq-mar. atri. aur. aur-m-n. Calc. calc-p. carc. chir-fl. cic. cygn-be. cypra-eg. Ferr-act. foll. Galeoc-c-h. germ-met. ignis-alc. kali-sil. lac-h. lach. lyc. Nat-m. nept-m. nid. nit-ac. nux-v. phos. positr. psor. puls. sabad. sal-fr. sanguis-s. Sulph. sumb. tritic-vg. tub. tung-met. vanil.
Food – STARCHY, food – desires
Alum. Calc. calc-p. cic. Ferr-act. LACH. LYC. Nat-m. nit-ac. nux-v. sabad. Sulph. sumb.
Food – CHARCOAL, desires
alum. Calc. Cic. con. ign. nit-ac. nux-v. Psor.
1. ICD-10 CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS , Reprinted edition 2004, World Health Organization 1992.
2. Nelson TEXTBOOK OF PAEDIATRICS, twentieth edition, Elsevier publications.
3. Kaplan and Sadock’s SYNOPSIS OF PSYCHIATRY , Eleventh Edition, Wolter’s Kluwer publications.
5. SYNTHESIS REPERTORY, SHROYENS F, SE92, Treasure Edition.
6. MURPHY REPERTORY, R. MURPHY, MUE300.