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Pica

Question
My 4-year-old son, who has been diagnosed with autism, eats inappropriate things like dirt and chalk. My neighbor says he might have pica. What is that?

Answer
The word "pica" comes from the Latin word for magpie, a bird known for its indiscriminate appetite. Pica is defined as an abnormal craving for non-food substances such as dirt, paint, or clay.

"People with developmental disabilities, including autism and mental retardation, often exhibit pica behavior, as do children between the ages of 2 and 3," explains Meredith Garrity, Ph.D., clinical director of May Instituteís school for children with autism in Arlington. "Children younger than 2 often put non-food items in their mouths, but that behavior is not considered unusual. It is estimated that as many as 25 to 30 percent of children develop pica. Individuals with brain injury or epilepsy and women who are pregnant may also develop pica."

Some of the non-food items that people with pica crave and consume include:
  • dirt
  • clay
  • paint chips
  • plaster
  • chalk
  • cornstarch
  • laundry starch
  • baking soda
  • coffee grounds
  • cigarette ashes
  • burnt match heads
  • cigarette butts
  • feces
  • ice
  • glue
  • hair
  • buttons
  • paper
  • sand
  • toothpaste
Although some of these items are harmless, some, such as lead-based paint chips, are dangerous and can cause lead poisoning. Children with pica may be at risk for other serious health problems including:
  • bowel problems (from consuming indigestible substances like hair)
  • dental injury (from eating hard items like buttons)
  • intestinal obstruction or perforation (from eating objects that could get lodged in the intestines)
  • parasitic infections (from eating dirt or feces)
"If your child has been eating non-edible items for more than a month, he should be evaluated to determine a cause for this behavior," Garrity advises.

Among the possible causes for pica are: anemia, nutritional deficiencies, developmental disabilities, sensory stimulation, lack of ability to discriminate between edible and non-edible items, anxiety, and other mental health conditions such as obsessive-compulsive disorder (OCD) and schizophrenia.

Some evidence supports the hypothesis that pica behaviors may develop in response to dietary deficiencies. For example, some pregnant women with pica have stopped eating nonfood items after being treated for iron deficiency anemia. People with pica who donít have a nutritional deficiency may respond well to the substitution of edible and/or sensory stimulating alternatives to non-edible items.

Teachers at May Instituteís school for children with autism and other developmental disabilities in Arlington, Mass., developed and implemented a successful intervention for a 5-year-old boy with autism who had a history of pica behavior. Each time the boy displayed pica behavior, a teacher interrupted the behavior and prompted him to throw the object away. This intervention was repeated ten times following each pica incident. Described as "contingent practice," this intervention was effective in reducing, and essentially eliminating pica in this case.

"Ensuring the safety of the individual with pica is paramount," advises Garrity. "I recommend that you consult with both medical and mental health professionals for appropriate assessment and treatment. Pica may be determined by multiple factors, and these professionals will consider your childís individual history when designing an effective intervention strategy."

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