Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016

Pica is an eating disorder that affects children and adults alike. It is characterized by the urge to eat non-food items such as clay, dirt, paper, paint, sand and potentially dangerous substances. Though not a very well-known disorder, the National Library of Medicine estimates that between 10-32 percent of children between the ages of 1 and 6 have pica. Although most children put edible and non-edible items in their mouths constantly, pica is differentiated by involving a compulsion to actually ingest a non-food item.


Definition & Facts

Pica is defined as the compulsive ingestion of nonfood items that completely lack nutritional value. The word “pica” comes from the Latin word for “magpie,” which is a bird well-known for its unusual eating habits. There are different subtypes of pica that categorize the patient further depending upon the substance he or she craves most.

Pica is most often found in children and pregnant women, but people battling mental disorders (such as schizophrenia and obsessive-compulsive disorder) are prone to having pica as well. This can be a dangerous disorder, especially if the person suffering is drawn to eating toxic items such as paint. Lead poisoning, nutritional deficiencies, intestinal obstructions and parasites are all risks that are associated with pica.

Symptoms & Complaints

Symptoms of pica vary widely depending on the individual, but all cases include the symptom of eating substances that aren’t meant for ingestion. Children and adults diagnosed with pica can find themselves eating hair, paint, dirt, clay, paper, soap, chalk, sand, ash, glue, animal feces, ice, coffee grounds, powders and whatever else they may be craving.

Many complications can arise from this dangerous eating disorder based on the substance consumed. Eating paint can cause lead poisoning which can ultimately lead to brain damage and learning disabilities in children.

There is also a huge risk of nutritional deficiencies because those that are afflicted with pica forgo healthy food for substances devoid of nutrients. Eating other problematic items can cause digestive issues like constipation, tears in the lining of the esophagus or intestines, and obstructions that could require surgery. Pica sufferers can also contract potentially deadly parasites or infections from eating dirt and sand.


There isn’t a single underlying cause for pica cases. Sometimes a nutrient deficiency, such as anemia, can be blamed. In addition, the hormones secreted during pregnancy can cause pica and put pregnant mothers at risk.

Other times it develops alongside another mental condition such as schizophrenia or OCD or it is a side effect of neglect and poverty. Other eating disorders can lead to pica as well. If someone is trying to lose weight, they may eat items that don’t contain calories to try and feel full without gaining weight. In some parts of the world, it’s acceptable to eat non-food items.

Diagnosis & Tests

There are no definitive tests to run if pica is suspected. Doctors will evaluate a patient’s medical history and eating habits and perform a physical examination to rule out other health issues first. It is very important that the patient be completely honest with his or her doctor to obtain a proper diagnosis. If a doctor suspects pica, a medical evaluation will be performed to assess malnutrition and possible anemia, look for intestinal obstructions, rule out parasites and infections and test for toxicity in the patient.

If there are symptoms, the doctor will treat those present and then evaluate any other present mental health conditions, such as OCD or developmental delays. The only tests that are performed are those that are needed to diagnose complications, like an X-ray to test for obstructions or blood tests to rule out anemia.

The Diagnostic and Statistical Manual of Mental Disorders classifies Pica as “persistent eating of nonnutritive substances for a period of at least one month; does not meet the criteria for either having autism, schizophrenia, or Kleine-Levin Syndrome; the eating behavior is not culturally sanctioned and the eating behavior occurs exclusively during the course of another mental disorder.”

Treatment & Therapy

Treatment will vary from patient to patient. If lead poisoning is present, a patient may be prescribed chelation therapy which could include ethylenediaminetetraacetic acid (EDTA) to remove the lead. Those with nutritional deficiencies will be prescribed vitamins or mineral supplements to regulate the body’s nutritional levels. Some cases may be treatable with iron supplements and dietary changes alone.

For those suffering from pica due to mental illness, psychological treatment with a trusted professional should be considered. Family therapy may be an option to deter the behavior. Positive reinforcement and behavior-based psychological treatment has been successful for patients with developmental delays and mental illness. Sometimes, psychologists help patients by retraining on proper food items and what is edible vs. inedible. Nutrition classes can be helpful and ongoing therapy may be needed to dissuade regression.

Prevention & Prophylaxis

There’s no known prevention of pica disorder. Since most cases of pica are diagnosed in children, the best way to curb this disorder is through education. Distinctions between edible and non-edible foods should be taught. Explanations should be given for why other items aren’t safe to ingest, along with the consequences of eating such things. Diligence is also important.

Children should be monitored closely and all non-food items should be stored out of reach. Making sure the child sticks to a daily multivitamin regimen and is offered well-balanced, nutritious meals is also important. For adults with developmental delays, re-education can be helpful, as well as maintaining proper nutrition. Pregnant mothers fearing pica should talk to their doctor and therapist along with eating well and taking a prenatal multivitamin daily.

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