If you’ve ever spent more than a few minutes with a toddler, you know they go through a phase where they put everything in their mouths, whether it’s food or not. Most children outgrow this habit. But if it sticks around, or starts in later childhood or adulthood, it could be a sign of pica (pronounced “PIE-kuh”), a condition where people eat things that aren’t food.
Pica can affect people of all ages. It’s most common in young children, pregnant women and people who have certain developmental or intellectual disabilities.
Tulasi Goriparthi, MD, a psychiatrist with Banner Health, helped us understand the signs and know when to get help.
What is pica?
Pica is an eating disorder where someone eats non-food items like these regularly for at least a month:
- Dirt, soil or clay
- Raw starch
- Charcoal
- Cloth
- Eggshells
- Ice
- Chalk
- Hair
- Paper or cardboard
- Soap or laundry detergent
- Paint chips
- Coffee grounds
- Ash
- Feces
- Baby powder
“The word pica comes from the Latin word for the magpie bird, a bird that gathers and eats different objects for the sake of curiosity,” Dr. Goriparthi said.
Pica is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a mental health condition. It’s usually seen in children, and it can happen on its own or along with other conditions like:
- Autism spectrum disorder
- Schizophrenia
- Trichotillomania (hair-pulling disorder)
- Obsessive-compulsive disorder (OCD)
“It is also a common eating disorder in people with intellectual disabilities,” Dr. Goriparthi said.
Some women also develop pica behaviors during pregnancy, especially if they have low levels of iron or zinc.
Pica may be underreported, because people with it don’t usually share their symptoms and providers usually don’t ask about it. In many cases, people feel self-conscious about consuming non-food items, so they keep it secret.
Eating non-food items isn’t considered pica in children under age 2. “These children are frequently eating non-nutritive substances, but they are only exploring and teething,” Dr. Goriparthi said.
Signs and symptoms of pica
Watch for these behaviors if you’re concerned about pica in yourself or someone else:
- Eating non-food items regularly
- Choosing non-foods in place of regular food
- Stomach pain, constipation or other digestive issues
- Signs of lead poisoning (from eating paint or soil) or signs of being exposed to other toxins
- Dental damage or worn teeth from hard or sharp items
- Nutritional deficiencies like low levels of iron or zinc
If these symptoms continue for more than a month, it’s time to seek help.
What causes pica?
There’s no single cause of pica. It could be caused by a mix of physical, behavioral and environmental factors. Some common contributors include:
- Nutritional deficiencies, especially low iron or zinc
- Developmental disabilities, such as intellectual delays
- Stress, trauma, anxiety, neglect or child abuse
- Changes in a person’s environment
- Mental health conditions like OCD
- Sensory-seeking behavior, especially in people who have autism
- A response to a medical condition
- Epilepsy
- Learned behavior
- Pregnancy
When to seek medical attention
You should contact a health care provider if pica:
- Happens regularly or daily
- Lasts for more than one month
- Continues after low nutrient levels are addressed
- Leads to health problems, lead poisoning or social issues
- Prevents normal eating
- Is happening in someone who is pregnant or has autism, intellectual disabilities or other factors that put them at higher risk
“If there are any other signs of ill health such as fever, cough, vision disturbances, problems with digestion, problems with losing weight or fatigue then the person needs to be evaluated immediately by a medical professional,” Dr. Goriparthi said.
How is pica diagnosed?
There are no specific tests for pica. A health care provider may:
- Ask about eating behaviors, nutrition, environment and how long the habit has lasted
- Assess habits based on DSM criteria for pica
- Review medical and developmental history
- Check for signs of related behavioral or mental health conditions
- Look for signs of poisoning or complications
- Run blood tests for iron, zinc, signs of lead poisoning and to check kidney, liver and vitamin levels
- Order abdominal x-rays
- Order a stool sample to check for worms
“Several psychiatric illnesses must be ruled out, including eating disorders, schizophrenia, autism, development delay in kids, anxiety disorders, substance abuse and addiction,” Dr. Goriparthi said.
Treating pica: What helps?
“There are no medications that specifically treat pica,” Dr. Goriparthi said. Treatment depends on what’s causing the condition. It often includes:
- Nutritional support, such as iron or zinc supplements
- Behavioral therapy to reduce harmful eating behaviors
- Antianxiety or antipsychotic medicine to treat some mental health conditions
- Mild aversive therapy, which pairs pica behaviors with discomfort or positive reinforcement in some cases
- Reducing access to non-food items or offering a substance with a similar texture
- Support for conditions like autism or OCD
- Parent or caregiver education to help with children who have pica
- Evaluating for cultural beliefs that support eating non-food items, since in some cultures eating things like clay, earth or ash is considered helpful for fertility or pregnancy
“Promptly diagnosing and treating pica is necessary for preventing complications,” Dr. Goriparthi said.
Complications may include:
- Constipation
- Nutritional deficiencies
- Infection with worms or parasites
- Lead, mercury, fluoride or arsenic poisoning
- Tooth decay or sensitivity
- High blood sugar
- Obesity
- Seizure disorder
- Digestive obstruction that can require surgery
- Long-term neurological problems in babies born to mothers who had pica during pregnancy
How Banner Health can help
At Banner Health, we offer compassionate care for people with pica. Whether you’re seeking support for a child, a loved one with a disability or mental health condition or yourself, our team can help with:
- Expert care from pediatricians, OB/GYNs, psychiatrists and developmental specialists
- Nutritional evaluations
- Behavioral health and therapy services
- Follow-up care
- Safe, respectful treatment for people of all abilities and ages
Concerned about pica? Reach out to a Banner Health provider today for help.
