Pica

PICA

Growing up, we all knew “the kid who eats dirt” and if you don’t remember “the kid,” it is likely because you were that kid.  And look at you now… you’ve grown up so nicely.  So how can eating dirt be a problem?

Pica, the act of consuming “non-food” items, is certainly not an emergent condition; however, you may be asked by a concerned parent about it or might even encounter a problem related to Pica… so let us explore it briefly.

 Pica Basics

  • The term “pica” is derived from the Latin name for a magpie bird (genus Pica) who reportedly ate everything.
  • Pica = developmentally inappropriate consumption of non-nutritive substances for at least 1 month.
    • So, if the toddler is eating mulch while at the park, it isn’t pica… it can still be dangerous though.
    • Additionally, if you eat clay for only 27 days… you don’t officially have a medical diagnosis of pica…
  • Pica is rather common (so many of us were likely “the kid who ate dirt” at one point or another).
    • 10-32% of children may have pica at some point.
    • Adults also can have pica (Pregnancy has been associated with odd cravings).
  • Associations between pica and behavioral disorders and/or mental retardation exists.
    • Having pica, however, does not infer an underlying behavioral or mental disorder.
  • Association of pica with Iron Deficiency is well documented.
    • From the evidence, it does not appear that pica leads to iron deficiency, but rather can be a symptom of it.
    • Iron supplementation has even shown to resolve pica in some.

What is eaten?

  • Essentially, anything.
  • Classics:
    • Dirt
    • Clay / Sand
    • Hair
    • Feces
    • Ice (although not a non-food item… many deem it an unusual obsession)
    • Paint
    • Glue
    • Wood (toothpicks are common)

Why we should care?

  • Firstly, because we care about everything… seriously… we see it all.
  • Secondly, it may be the first a family has been told that it could be related to iron deficiency.
    • They have been concerned that their child has a weird medical problem… and afraid.
    • If not pursued, anemia may go unrecognized for years.
  • Thirdly, serious complications can occur.
    • Bezoar (not only fun to say, but dangerous to one’s health)
    • Lead poisoning (from ingesting dust or paint)
    • Parasitic infection (particularly from ingesting dirt/clay)

What should be done?

  • Ok, it isn’t an emergency, in general… but…
  • Look for signs of anemia (pallor, tachycardia, spooning of nails, fatigue, etc)
    • If present, consider a Hgb level.
    • Even if not present, still refer to primary pediatrician for further assessment.
  • Specifically, consider lead poisoning:
    • Lead builds up over time and can lead to significant health problems.
    • Symptoms:
      • Abdominal pain and cramping
      • Constipation
      • Signs of Anemia
      • Headaches
      • Irritability
      • Loss of developmental skills
    • Very high lead levels lead to:
      • Vomiting
      • Ataxia
      • Seizures
      • Muscle Weakness
      • Coma

So, while pica may not generally be an emergent topic… it is one that having some knowledge of can benefit you patients… and that is the goal of the game.

Moore DF, Sears DA. Pica, Iron Deficiency, and the Medical History. American Journal of Medicine. 1994; 97(4): 390-393.

T.E.C Jr. The Origin of the Word Pica. Pediatrics. 1969; 44(4): 548.

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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1 Response

  1. Dr. Colucciello says:

    Don’t forget about Cautopyreiophagia (injection of burnt match heads leading to hyperkalemia)

    I’ve only seen about 5 or 6 of these cases J

    Dr. C

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