Pica

PICA

Pica is defined as a habit disorder characterized by perversion of appetite in which there is persistent purposeful ingestion of apparently unsuitable substances seemingly without any nutritive value.

PATHOPHYSIOLOGY -

Soon after adequate motor control is achieved by the child, he passes through a hand-to-mouth stage of development in the second half of first year. Babies at this age are very clever in finding small objects to put into the mouth. At this time pica is a developmental phenomenon and begins to disappear by 12 months. If it persists beyond 18 months, it is considered abnormal. There appears to be an element of compulsivity about an older child's pica. Children who can communicate well express an irresistible craving for certain non-food substances.

AETIOLOGICAL FACTORS -

Iron deficiency (anaemia may or may not be present)-

Many children have been shown to have iron deficiency & the pica disappears on giving supplemental iron.

Hence, pica is considered to be an instinctive urge in children with iron deficiency anaemia.

Iron deficiency and pica have a clear association in adults with pagophagia (ice eating).

More common in mentally subnormal children.

More common in children belonging to low socio-economic strata.

More common in undernourished children.

Family history of pica is well known.

Child neglect and poor supervision.

Cultural factors- In certain communities, mud eating is encouraged.

Worm infestation- Controversy exists as to whether worms in intestine lead to pica or pica with eating of mud and other unhygienic objects leads to worm infestation.

Poor parenting and prolonged parental absence.

Emotional deprivation of the child.

SUBSTANCES COMMONLY INGESTED IN PICA -

1)Clay and dirt

2)Mud (Geophagia)

3)Starch (Amylophagia)

4)Paint

5)Pencil

6)Lead

7)Plaster

8)String

9)Leaves

10) Ash

11) Wool/Cloth

12) Ice (Pagophagia)

13) Nails/Hair

14) Coal

15) Cigarette butts

16) Soap etc.

DANGERS ASSOCIATED WITH PICA -

Risk of infections e.g. Gastroenteritis, bacillary dysentery.

Injury e.g. perforation of viscus due to sharp object.

Worm infestation (Cause/Effect??)

Intestinal obstruction.

Lead poisoning.

Recurrent vomiting.

MANAGEMENT -

Rule and treat all organic factors if present.

Stool examination- Vermicidal drugs/ vermifuge if eggs/ worms are present in stools.

Hb, CBC, ESR- Look for iron deficiency anaemia and treatment with elemental iron.

Counselling of parents- Removal of parental anxiety.

Adequate supervision- Keep the substances for which the child has a craving out of reach of the child. Ca Management of inadequate parenting, lack of emotional stimulation or correction if the parent is serving as a role model for pica.

An older child with persistent pica requires psychiatric referral & may require behaviour reinforcement. Alteration in physical environment is helpful.

Screening for iron deficiency and lead poisoning must always be done.