Introduction: Pica is an act or habit of eating non edible things such as clay, paints, ashes,chalk, pencil,plaster from wall, earth, scalp hair,stone,brick,soap,paper etc.
The term is derived from “pica-pica,” the Latin word for the magpie bird, because of the bird’s indiscriminate gathering and eating a variety
of objects for the sake of curiosity.[1]
ETIOLOGY
1.Parental neglect and abuse
2.Poor attention of caregiver
3.Inadequate love & affection
4.It is common in poor socio economic families and in malnourished and mentally subnormal children.
5.Iron deficiency anemia
6.Many population-based studies have found a low level of serum iron/ferritin (and other micronutrients) among patients with pica.[2][3][4].
7.Cultural and learned behaviors
8.Stress or anxiety
9.Nutritional deficiencies
10.Medical condition in pregnancy and sickle cell anemia.
Clinical features:
Children with pica may have associated problems of intestinal parasitosis, lead poisoning, vitamins and mineral deficiency.
These children may have problems like trichotillomania (pulling out of scalp hair and swallow) & trichobezoar (a big palpable lump in the upper abdomen due to collection of swallowed hair).
Diagnostic criteria[5]:Persistent eating of non-nutritive,non-food substances over a period of at least 1 month.
2.The eating of non-nutritive, non-food substances is Inappropriate to the developmental level of the individual.
Differential Diagnosis:
Several psychiatric illnesses should be considered in the differential diagnosis including other eating disorders, schizophrenia and psychosis, autism and developmental delay in children, substance abuse, and addiction.[6][7]
Homoeopathic management:
I. Calcarea carbonica
This medicine is obtained from oyster shells. It is best suited to the people of the leucophlegmatic Constitution. Patients who are fat, fair and flabby. There will be a peculiar craving for indigestible things like chalk, coal, pencils, flour and raw potatoes.Severe pain in the epigastric region during touch.
Aggravation while eating. Indicated remedy for hypochlorhydria[8]
2. Alumina
Best suited for hypochondriac constitution persons of sedentary habits who suffer from chronic ailments. Patients will have abnormal cravings for chalk, charcoal, dry food and tea grounds. Abdominal colic will be present like painter’s colic. Constipation of old people and infant’s due to an inactive rectum. Evacuation of stool is preceded by painful urging long before stool and straining[8].
3. CINA
Persons who need this medicine have one cheek pale and the other cheek red. Face with a bluish appearance around the mouth and dark rings under the eyes. Another important medicine for desire for indigestible things. It is also a very significant medicine for persons who crave indigestible things. Children smell sour mother tells child has worm breath [9], Gastric disorders with helminthiasis [7], Constant digging of nose and boring rubs nose over pillow
[10].4.LAC Felinum
This medicine is obtained from cat’s milk. Person who needs this medicine particularly will have a strange desire to eat paper after eating, feels swollen and has to take off her dress and loose clothes. They may also complain of soreness and sensitiveness of the stomach region. Sensation of hot feeling felt in the epigastric region of the stomach. There is a very slight nausea and loss of appetite with these symptoms [7]
5.Silicea terra
This medicine is useful for persons who have a desire to eat mud. Sensation of hair in tongue. Great aversions to meat. They have loss of appetite with aversion to eating cooked food. Constipation may be present great difficulty in passing the stool. The stool when partly expelled from the anus recedes back in the rectum [8] , During deglutition food ascends into nasal fossae[11]
6.Terentula hispanica
Medicine obtained from spanish spiders. This medicine is indicated for extremely restless cases where the desire for eating sand,raw food,and ashes. Along with this ,there is loss of appetite with a refusal of eating. Sometimes food taste bitter,salty and bland or swedish.[11]
Refrence:
1.Johnson BE. Pica. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; Boston: 1990. [PubMed]
2.Nchito M, Geissler PW, Mubila L, Friis H, Olsen A. Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Trans R Soc Trop Med Hyg. 2004 Apr;98(4):218-27. [PubMed]
3.Geissler PW, Shulman CE, Prince RJ, Mutemi W, Mnazi C, Friis H, Lowe B. Geophagy, iron status and anemia among pregnant women on the coast of Kenya. Trans R Soc Trop Med Hyg. 1998 Sep-Oct;92(5):549-53. [PubMed]
4.Cavdar AO, Arcasoy A, Cin S, Babacan E, Gözdasoğlu S. Geophagia in Turkey: iron and zinc deficiency, iron and zinc absorption studies and response to treatment with zinc in geophagia cases. Prog Clin Biol Res. 1983;129:71-97. [PubMed]
5.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5@).American Psychiatric Pub 2013.
6.Rabel A, Leitman SF, Miller JL. Ask about ice, then consider iron. J Am Assoc Nurse Pract. 2016 Feb;28(2):116-20. [PMC free article] [PubMed]
7.Kar SK, Kamboj A, Kumar R. Pica and psychosis – clinical attributes and correlations: a case report. J Family Med Prim Care. 2015 Jan-Mar;4(1):149-50. [PMC free article] [PubMed]
8.Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory: Comprising of the Characteristic and Guiding Symptoms of All Remedies (Clinical and Pathogenetic [sic]) Including Indian Drugs. B Jain publishers 2002.
9.Kent JT. Lectures on homeopathic Materia Medica: together with Kent’s New Remedies Incorporated and arranged in one alphabetical order. B. Jain Publishers 1989.
10. Allen HC. Allen’s Keynotes Rearranged & Classified: With Leading Remedies of the Materia Medica & Bowel Nosodes B. Jain 2018.
11. Clarke JH. A dictionary of practical materia medica. Homeopathic publishing Company 1902
About the Author:
Dr. Dharmendra Kumar Saini, Assistant Professor, Department of Practice of Medicine, University College of Homoeopathy, Jodhpur, Rajasthan.
