Pica in Children and Adolescents


ICD-10 Code: F98.3

Pica is part of a cluster of diagnoses called the feeding and eating disorders.  Feeding and eating disorders are a group of psychiatric conditions that include:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Pica
  • Avoidant/restrictive food intake disorder

Feeding and eating disorders are characterized by a persistent disturbance in eating behaviors.  These disorders are linked to alterations in the consumption of food or absorption of nutrients, and can result in severe distress, physical health problems, and psychosocial impairment.  People with anorexia nervosa are significantly underweight because they eat very little food in an effort to lose weight or prevent weight gain.  People with binge eating disorder and bulimia nervosa eat large quantities of food in a short period of time (called a "binge"); people with bulimia nervosa also attempt to prevent weight gain by compensating for these binges in an inappropriate way, usually by vomiting, excessively exercising, fasting, or misusing laxatives or other medications.  People with pica regularly eat non-nutritious, non-food substances.  People with avoidant/restrictive food intake disorder have little interest in food or avoid many types of foods, which results in nutrition deficits.

Several of these disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are characterized by serious disturbances in body image and a preoccupation with weight and shape.  Other disorders, including pica  and avoidant/restrictive food intake disorder, are characterized by atypical eating behaviors but are not prominently associated with body image disturbances.  Some feeding and eating disorders, including anorexia nervosa and avoidant/restrictive food intake disorder, cause the individual to be significantly underweight or malnourished as a result of their eating behaviors.  Other disorders, including bulimia nervosa and binge eating disorder, do not produce marked weight loss and are typically associated with normal or higher than expected weight.

What is Pica?

Pica is a relatively rare psychiatric disorder that is more common in children than in adults, although the exact prevalence in children is unknown.  Pica is characterized by persistent consumption of nonnutritive, nonfood substances (e.g., dirt, paint, gum, chalk, string, ice, or pebbles).

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Understanding Pica

Pica severity can range from mild to very severe.  In severe cases, pica can lead to serious medical complications, including gastrointestinal injury or obstruction, acute weight loss, malnutrition, or poisoning.

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How is pica treated?

Currently there are no published guidelines on the best way to treat pica.  However, clinical research suggests the following treatments are effective:

    • Behavioral interventions, which aim to reduce pica by rewarding the absence of pica-related behaviors and punishing (via verbal reprimands or mild physical punishments) the occurrence of pica-related behaviors.  
  • Iron supplementation

 

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