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Pica

Definition

Pica is a pattern of eating non-food materials, such as dirt or paper.

Alternative Names

Geophagy; Lead poisoning - pica

Causes

Pica is seen more in young children than adults. Up to one third of children ages 1 to 6 have these eating behaviors. It is unclear how many children with pica intentionally consume dirt (geophagy).

Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron and zinc, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

Symptoms

Children and adults with pica may eat:

  • Animal feces
  • Clay
  • Dirt
  • Hairballs
  • Ice
  • Paint
  • Sand

This pattern of eating must last for at least 1 month to fit the diagnosis of pica.

Depending on what is being eaten and how much, symptoms of other problems may be present, such as:

  • Belly pain, nausea, and bloating caused by blockage in the stomach or intestine
  • Fatigue, behavior problems, school problems and other findings of lead poisoning or poor nutrition

Exams and Tests

There is no single test for pica. Because pica can occur in people who have poor nutrition, the health care provider may test blood levels of iron and zinc.

Blood tests can also be done to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead paint dust to screen for lead poisoning.

The provider may also test for infection if the person has been eating contaminated soil or animal waste.

Treatment

Treatment should first address any missing nutrients or other medical problems, such as lead poisoning.

Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets rewarded for eating normal foods.

Medicines may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability.

Outlook (Prognosis)

Treatment success varies. In many cases, the disorder lasts several months and then disappears on its own. In some cases, it may continue into the teen years or adulthood, especially when it occurs with developmental disorders.

Possible Complications

Complications include:

  • Bezoar (a mass of undigestible material trapped inside the body, most often in the stomach)
  • Infection

When to Contact a Medical Professional

Call your provider if you notice that a child (or adult) is eating nonfood materials.

Prevention

There is no specific prevention. Getting adequate nutrition may help.

References

Ginder GD. Microcytic and hepochromic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 159.

Katz ER, Kitts RL, DeMaso DR. Rumination and pica. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 23.

Katzman DK, Kearney SA, Becker AE. Feeding and eating disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 9.

Review Date:2/21/2016
Reviewed By:Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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