Written by Dr Kaylene Henderson, Little Children Big Dreams
What is Pica?
It is common for very young children, under the age of 18 months, to put a range of things (other than food) in their mouths as they learn about their environment. However, repeatedly eating items which are considered 'non-nutritive' (i.e. not food) after that age is generally considered abnormal. These non-foods can include clothing, paper, toothpaste, hair, glass, paint, string, stones, dirt...the list goes on. It seems to depend primarily on how mobile the child is as to what items they can access.
The word 'pica' is defined differently depending on where you look but the DSM-IV* (the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders) calls for "persistent eating of non-nutritive substances for at least one month that's developmentally inappropriate and not culturally sanctioned and severe enough to warrant clinical attention". This therefore excludes some cultural practices such as the eating of clay or soil in various parts of the world.
How common is Pica?
Because of the inconsistencies in the definition and due to the general under-reporting of these things, it's difficult to know how prevalent pica is among children. That said, figures of between 10-30% of young children are often quoted. It seems to be most common amongst 2-3 year olds with the incidence reducing as they get older. It also seems to be much more often seen among children with an autistic spectrum disorder or intellectual disability. Boys and girls are affected equally.
Why does it happen?
Researchers haven't found the answer to this yet and, as is often the case, it's likely that pica occurs in different children for different reasons. Some children with pica are found to have low iron and/or zinc levels. There has also been a suggestion that pica might be a compulsion for some kids, like those seen in OCD (Obsessive Compulsive Disorder). Some other children seem simply to like the sensation of different textures and objects in their mouths.
Is Pica dangerous?
This will depend on what the child is ingesting. Worrying non-foods include faeces or soil which might expose the child to parasitic infections, lead-based paint, gravel or stones which might damage the child's teeth or cause intestinal blockages.
What to do?
Even though pica in children with normal intelligence usually resolves without treatment by the time they're teenagers, all kids with pica should be reviewed by their General Practitioner (GP).
1. What your GP will do:
Your Doctor will want to consider what is causing the pica for your child and look for any evidence of harm caused. He/she might also ask questions about what access your child has to dangerous items and about signs of autism and intellectual impairment given that these conditions sometimes occur together. Your child might need a blood test to check for mineral deficiencies. Depending on the duration and severity of your child's pica, your Doctor may suggest a referral to a Paediatrician, Child Psychiatrist or Psychologist.
2. What you can do:
Learn about pica and try to prevent your child's exposure to dangerous items. Consider locking up things such as bleach, paint, cleaning liquids. For those children who appear to seek the sensation of different textures in their mouths, popcorn can sometimes be a useful alternative. If no other cause for your child's pica is found, try to notice whether there are triggers for your child's pica behaviour and talk to your GP about whether behavioural strategies might be helpful.
*American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. American Psychiatric Press;2000:103-105.
Dr Kaylene Henderson
MBBS FRANZCP Cert C&A Psych
Dr Kaylene Henderson is a Child & Adolescent Psychiatrist and Founder of Little Children Big Dreams which provides online help for children who are afraid of the dark or scared of monsters - http://www.littlechildrenbigdreams.com/
Little Children Big Dreams offers personalized printable stories and parent guides to help children beat their fears of monsters or fears of the dark and sleep better at night. Parents are also invited to read Dr Kaylene Henderson's blog on the Little Children Big Dreams website or to visit the Little Children Big Dreams Facebook page for parenting tips and Child Psychiatry information - http://www.littlechildrenbigdreams.com/.