Pica
An eating disorder involving persistent eating of non-nutritive, non-food substances for at least one month. The behavior is developmentally inappropriate (not part of normal infant/toddler exploration) and not culturally sanctioned. Common substances include ice, clay, dirt, sand, paper, soap, cloth, hair, string, paint chips, or chalk.
Prevalence: Exact prevalence unknown due to underreporting. Estimates: 4-26% in institutionalized populations, 8-31% in pregnant women (often ice eating), 10-32% in children. More common with intellectual disabilities (up to 25%).
Common Symptoms
- Persistent eating of non-food substances for 1+ month
- Substances commonly consumed: ice (pagophagia), clay/dirt (geophagia), paper, chalk, soap, cloth, hair (trichophagia), string, paint chips, starch (amylophagia)
- Behavior is not developmentally appropriate (beyond age 2)
- Not part of cultural practice or socially normative behavior
- Compulsive or difficult-to-resist urges to eat non-food items
- May hide the behavior due to embarrassment
- Physical complications depend on substance consumed:
- - Intestinal obstruction or blockage
- - Constipation or diarrhea
- - Abdominal pain or cramping
- - Dental damage (broken teeth, enamel erosion)
- - Lead poisoning (from paint chips)
- - Parasitic infections (from dirt/soil)
- - Nutritional deficiencies (especially iron deficiency anemia)
- - Bezoars (mass of indigestible material in digestive tract)
- - Perforated intestine (rare but serious)
Risk Factors
- Iron deficiency anemia (strongest risk factor)
- Pregnancy (especially ice eating)
- Intellectual disability (significantly increased risk)
- Autism spectrum disorder
- Schizophrenia or other psychotic disorders
- Obsessive-compulsive disorder
- Developmental delays
- History of child abuse or neglect
- Malnutrition or food insecurity
- Family history of pica
- Living in poverty
- Chronic medical conditions affecting nutrition
Treatment Approaches
- Medical treatment of nutritional deficiencies (primary intervention)
- Iron supplementation for iron deficiency anemia
- Behavioral therapy (habit reversal, operant conditioning)
- Differential reinforcement of alternative behaviors
- Stimulus control (environmental modification)
- Cognitive Behavioral Therapy (awareness, triggers, alternative responses)
- Address underlying psychological conditions (OCD, anxiety)
- Family therapy and parent training (for children)
- Occupational therapy for sensory needs
- Medical monitoring for complications
- Treatment of lead poisoning or parasitic infections if present
- Surgical intervention if intestinal obstruction occurs
- Medications: typically not first-line, may use:
- - SSRIs if co-occurring OCD or anxiety
- - Antipsychotics for severe cases with psychotic features
- Psychoeducation about risks and health consequences
- Multidisciplinary approach (medical + behavioral + nutritional)
Self-Help & Natural Approaches
- Iron supplementation (if iron deficiency confirmed)
- Correct any nutritional deficiencies (zinc, calcium, vitamins)
- Increase dietary sources of deficient nutrients
- Environmental modification (remove access to non-food items)
- Behavioral interventions (habit reversal, differential reinforcement)
- Provide safe alternatives for oral stimulation (chewing gum, crunchy foods)
- Increase environmental enrichment and stimulation
- Stress reduction techniques
- Mindfulness and awareness training (for urges)
- Distraction and redirection when urges occur
- Regular meals and snacks to prevent excessive hunger
- Positive reinforcement for not engaging in pica
- Self-monitoring and keeping diary of urges and triggers
- Oral sensory activities as substitutes
- Supervision and safety measures (especially for children)
- Social support and reducing isolation
- Engaging hobbies and meaningful activities
- Education about risks and complications
When to Seek Professional Help
- Persistent eating of non-food substances for over 1 month
- Suspected nutritional deficiency (fatigue, weakness, pale skin)
- Abdominal pain, constipation, or other GI symptoms
- Suspected lead exposure (eating paint chips)
- Dental damage from eating hard substances
- Behavior interferes with daily life or social functioning
- Child engaging in pica beyond developmentally appropriate age
- Eating potentially toxic or dangerous substances
- Signs of intestinal blockage (severe pain, vomiting, no bowel movements)
- Co-occurring intellectual disability or developmental delay
- Pregnancy with persistent pica
- Family concerned about the behavior
Crisis Resources
- Poison Control: 1-800-222-1222 (if toxic substance ingested)
- Emergency: 911 (if signs of intestinal obstruction or serious symptoms)
- National Eating Disorders Association (NEDA): 1-800-931-2237
- SAMHSA National Helpline: 1-800-662-4357
- 988 Suicide & Crisis Lifeline: Call or text 988
- National Alliance on Mental Illness (NAMI): 1-800-950-6264
- Primary care provider or pediatrician for medical evaluation
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.