Pica by Ray Sahelian, M.D.
January 20 2016

Pica is an eating disorder where an individual eats substances that have no nutritional value. Pica is considered abnormal when it occurs after a certain age, for instance after age 2 or 3. Individuals presenting with pica have been reported to ingest a wide variety of nonfood substances, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, and cigarette butts.

Pica is seen more in young children than adults, with 10-32% of children aged 1 to 6 exhibiting these behaviors. Pica can occur during pregnancy. In some cases, specific nutritional deficiencies, such as iron deficiency anemia and zinc deficiency, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

Signs and tests for Pica
There is no single test that confirms pica, but because pica is associated with abnormal nutritient levels and in some cases malnutrition, blood levels of iron and zinc should be tested. Hemoglobin can also be checked to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The presence of infection may be detected if contaminated soil or animal waste is being ingested.

Res Dev Disabil. 2012. Assessment, behavioral treatment, and prevention of pica: clinical guidelines and recommendations for practitioners. Pica is a dangerous form of self-injurious behavior that occurs in people with developmental disabilities who are institutionalized. Studies also indicate that pica has led to the death of people with developmental disabilities. While a number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment, few of these studies incorporated strategies for generalization and maintenance outside of brief sessions. A second limitation of current research is that some studies reduced pica substantially, but pica responses still occurred at rates that are problematic in terms of prevention of adverse consequences, which leaves practitioners with the task of further decreasing pica to protect people exhibiting pica from harm. We make recommendations for assessment, treatment, and prevention of pica for practitioners. These recommendations are based on two extensive reviews of the literature and our extensive experience as practitioners in the treatment of pica. Our hope is that administrators, professionals and practitioners will consider our guidelines and recommendations as they attempt to protect people with pica and developmental disabilities from harm by developing standards for assessment, treatment and prevention for this difficult-to-treat population. Our hope is that children with pica will receive early intervention to prevent pica from developing into life-threatening behavior.

Pregnancy
Rev Bras Ginecol Obstet. 2015. Nutritional and psychological factors associated with the occurrence of pica in pregnant women. Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to opt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.

Questions
Q. I came to your website when searching for pica eating habit of pencil needle. I had this habit when I was a child and now I am 28 and after a long gap suddenly I am getting a pica craving for pencil needles or pencil lead. What are the health side effects for it and any idea how I can stop it?
     A. We're not an expert in this pica pencil needle eating habit topic.

What do you have for iron deficiency anemia? I had this years ago and also the ice-eating pica that sometimes goes with it. I have developed the pica again and would like to get what I need from your products.