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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
What’s on the menu today? If it’s paint, soil, ice, chalk, glue, or another similarly non-nutritional item, you might be looking at a case of pica eating disorder. Pica isn’t as well known as some other eating disorders, like anorexia nervosa or bulimia, but it’s common in certain populations.
What is pica eating disorder?
Pica eating disorder is the compulsive eating of non-food items. These items might be paint, soil or clay, laundry starch, ice, feces, chalk, glue, coffee grounds, eggshells, or many other things (Al Nasser, 2020).
Pica has been known as a medical condition for well over 2,000 years. The term “pica” comes from the Latin word for the magpie bird because magpies are said to gather and eat many different objects (Rabel, 2015).
How is pica diagnosed?
For a diagnosis of pica, a person must have eaten non-edible items for at least a month. If eating that item is part of a cultural tradition, it’s not considered pica. For instance, clay eating is considered normal in some parts of Africa and the Middle East. Also, eating non-edible items isn’t deemed abnormal in children under 24 months of age (Al Nasser, 2020).
What are the risks of pica?
The risks of pica depend on what’s being eaten (Al Nasser, 2020):
- Paint chips or clay—If these items contain lead, there’s a serious concern about lead poisoning. Lead poisoning can cause neurological problems (like seizures and coma); behavioral problems (like difficulty paying attention or focusing); and digestive problems (like abdominal pain, anorexia, and vomiting) (Hauptman, 2017)
- Laundry starch—Eating laundry starch can lead to iron deficiency, high blood sugar, and obesity.
- Ice—While eating ice is relatively harmless, overeating it can lead to iron deficiency, as well as tooth decay and sensitivity.
- Soil or clay—The most significant risks are constipation, low potassium levels, nutritional deficiencies, intestinal blockages, lead poisoning, and bacteria or parasite infection. Parasite infection can be severe, with symptoms including fever, fatigue, coughing, wheezing, abdominal pain, vision loss, retina damage, and eye inflammation (Woodhall, 2017).
- Rocks or stones—Eating these can lead to constipation and blockages in the digestive tract.
- Sharp objects—Eating sharp objects can cause digestive problems, like pain, bleeding, and infection. Items like metal scraps can tear the lining of the esophagus, stomach, and intestines.
Rumination disorder: symptoms and treatments
Who’s at risk for developing pica eating disorder?
- People with a family history of pica
- Children, especially children of lower socioeconomic status (Leung, 2019)
- Pregnant, menstruating, or lactating women (Rabel, 2016). One study found that a whopping 28% of pregnant women worldwide have pica (Fawcett, 2016).
- People with developmental or intellectual disabilities
- People with mental disorders, including schizophrenia, obsessive-compulsive disorder (OCD), degenerative neurological diseases (such as Alzheimer’s), and psychosis (Kar, 2015; Funayama, 2018; Rabel, 2016)
- People with nutritional deficiencies, especially iron and zinc (Miao, 2015). Low levels of iron are the most common cause of anemia.
What causes pica?
There’s no known direct cause of pica. In some people, especially those with OCD, pica is considered a mental health disorder (Al Nasser, 2020; Kar, 2015).
Eating soil and clay is linked with iron and zinc deficiencies. Some researchers think that people eat these substances to supplement these deficiencies. These researchers point out that eating soil or clay doesn’t increase a person’s levels of iron. But it’s also possible that eating the soil or clay is actually causing the deficiencies by absorbing nutrients from the digestive system (Al Nasser, 2020; Miao, 2015).
There might be other physiological reasons for eating soil or clay. In pregnant women, these substances may bind with toxins and keep them away from the developing embryo when it’s most likely to be damaged by them (Al Nasser, 2020). Of course, there are also significant potential risks of eating soil or clay, so it’s not worth trying at home.
Ice eating is a form of pica linked with anemia, which can make you feel weak and tired. People with anemia may eat ice because it can stimulate increased blood flow to the brain. This increases their alertness and makes them feel less tired (Rabel, 2016).
What are the tests for pica?
There’s no specific test for pica eating disorder. Because the symptoms of pica can vary so much, depending on what substance is being eaten, testing varies widely. Your provider may order comprehensive tests for gastrointestinal obstruction, infection by bacteria or parasites, lead toxicity, and nutritional deficiencies (Al Nasser, 2020).
Your provider may also inspect your teeth for damage from eating hard objects. You might also be assessed for other psychological conditions.
Stress eating: what is it and how do you stop it?
What’s the treatment for pica?
Pica isn’t necessarily treated. In pregnant women, pica usually spontaneously disappears (Al Nasser, 2020). However, if you’re pregnant and are experiencing pica, it’s still worth discussing with your healthcare provider. They might want to check for any nutritional deficiencies or other conditions that could affect you and your baby.
In most young children, pica usually disappears after they’ve been taught the difference between edible and inedible substances (Leung, 2019). In children and adults with learning disabilities, behavioral therapy usually stops pica (McNaughten, 2017; Call, 2015).
If tests show that you have nutritional deficiencies, you might need to take dietary supplements or change your diet. For instance, if you have iron-deficiency anemia, you may need iron supplements for iron replacement.
People with other mental health conditions might be prescribed medications to treat their condition (Kar, 2015).
Talk to your healthcare provider if you’re concerned about pica.
- Al Nasser Y, Muco E, Alsaad AJ. (2020). Pica. [Updated 2020 Dec 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532242/
- Call, N. A., Simmons, C. A., Mevers, J. E., & Alvarez, J. P. (2015). Clinical outcomes of behavioral treatments for pica in children with developmental disabilities. Journal of autism and developmental disorders, 45(7), 2105–2114. doi: 10.1007/s10803-015-2375-z. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25636679/
- Fawcett, E. J., Fawcett, J. M., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 133(3), 277–283. doi: 10.1016/j.ijgo.2015.10.012. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26892693/
- Funayama M. (2018). Pica. Brain and nerve = Shinkei kenkyu no shinpo, 70(11), 1173–1180. doi: 10.11477/mf.1416201162. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30416110/
- Hauptman, M., Bruccoleri, R., & Woolf, A. D. (2017). An update on childhood lead poisoning. Clinical pediatric emergency medicine, 18(3), 181–192. doi: 10.1016/j.cpem.2017.07.010. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645046/
- Kar, S. K., Kamboj, A., & Kumar, R. (2015). Pica and psychosis – clinical attributes and correlations: a case report. Journal of family medicine and primary care, 4(1), 149–150. doi: 10.4103/2249-4863.152277. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366992/
- Leung, A., & Hon, K. L. (2019). Pica: A common condition that is commonly missed – an update review. Current pediatric reviews, 15(3), 164–169. doi: 10.2174/1573396315666190313163530. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30868957/
- McNaughten, B., Bourke, T., & Thompson, A. (2017). Fifteen-minute consultation: the child with pica. Archives of disease in childhood. Education and practice edition, 102(5), 226–229. doi: 10.1136/archdischild-2016-312121. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28487433/
- Miao, D., Young, S. L., & Golden, C. D. (2015). A meta-analysis of pica and micronutrient status. American journal of human biology : the official journal of the Human Biology Council, 27(1), 84–93. doi: 10.1002/ajhb.22598. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270917/
- Rabel, A., Leitman, S. F., & Miller, J. L. (2016). Ask about ice, then consider iron. Journal of the American Association of Nurse Practitioners, 28(2), 116–120. doi: 10.1002/2327-6924.12268. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635104/
- Woodhall, D. M., Garcia, A. P., Shapiro, C. A., Wray, S. L., Shane, A. L., Mani, C. S., et al. (2017). Assessment of U.S. pediatrician knowledge of toxocariasis. The American journal of tropical medicine and hygiene, 97(4), 1243–1246. doi: 10.4269/ajtmh.17-0232. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637614/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.