Generic placeholder image

Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Review Article

Pica: A Common Condition that is Commonly Missed - An Update Review

Author(s): Alexander K.C. Leung* and Kam Lun Hon

Volume 15, Issue 3, 2019

Page: [164 - 169] Pages: 6

DOI: 10.2174/1573396315666190313163530

Abstract

Background: Pica is a common condition in childhood that is commonly missed.

Objective: To familiarize physicians with the clinical evaluation and management of children with pica.

Methods: A PubMed search was completed in Clinical Queries using the key term "pica" OR “dirteating”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.

Results: Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual’s emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.

Conclusion: Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.

Keywords: Pica, anemia, lead poisoning, malnutrition, mental retardation, dirt-eating.

Graphical Abstract
[1]
Leung AK. Pica. Common Problems in Ambulatory Pediatrics: Anticipatory Guidance in Behavioral Pediatrics 2011; 109-12.
[2]
Leung AK. Pica. Can J Pediatr 1999; 1(1): 4-7.
[3]
Al Nasser Y, Alsaad AJ. Pica StatPearls Internet. Treasure Island, FL: StatPearls Publishing 2018. 2018 Oct 27
[4]
McNaughten B, Bourke T, Thompson A. Fifteen-minute consultation: the child with pica. Arch Dis Child Educ Pract Ed 2017; 102(5): 226-9.
[http://dx.doi.org/10.1136/archdischild-2016-312121] [PMID: 28487433]
[5]
Hartmann AS, Poulain T, Vogel M, Hiemisch A, Kiess W, Hilbert A. Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study. Eur Child Adolesc Psychiatry 2018; 27(11): 1499-508.
[http://dx.doi.org/10.1007/s00787-018-1153-9] [PMID: 29675593]
[6]
Castiglia PT. Pica. J Pediatr Health Care 1993; 7(4): 174-5.
[http://dx.doi.org/10.1016/0891-5245(93)90041-F] [PMID: 8350239]
[7]
Mishori R, McHale C. Pica: an age-old eating disorder that’s often missed. J Fam Pract 2014; 63(7): E1-4.
[PMID: 25198212]
[8]
Fawcett EJ, Fawcett JM, Mazmanian D. A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet 2016; 133(3): 277-83.
[http://dx.doi.org/10.1016/j.ijgo.2015.10.012] [PMID: 26892693]
[9]
Golden CD, Rasolofoniaina BJ, Benjamin R, Young SL. Pica and amylophagy are common among Malagasy men, women and children. PLoS One 2012; 7(10)e47129
[http://dx.doi.org/10.1371/journal.pone.0047129] [PMID: 23082143]
[10]
Murray HB, Thomas JJ, Hinz A, Munsch S, Hilbert A. Prevalence in primary school youth of pica and rumination behavior: The understudied feeding disorders. Int J Eat Disord 2018; 51(8): 994-8.
[http://dx.doi.org/10.1002/eat.22898] [PMID: 30175409]
[11]
Ardeshirian KA, Howarth DA. Esperance pica study. Aust Fam Physician 2017; 46(4): 243-8.
[PMID: 28376581]
[12]
Borgna-Pignatti C, Zanella S. Pica as a manifestation of iron deficiency. Expert Rev Hematol 2016; 9(11): 1075-80.
[http://dx.doi.org/10.1080/17474086.2016.1245136] [PMID: 27701928]
[13]
Khan Y, Tisman G. Pica in iron deficiency: a case series. J Med Case Reports 2010; 4: 86.
[http://dx.doi.org/10.1186/1752-1947-4-86] [PMID: 20226051]
[14]
Moore DJ. Sapophagia: A case of Irish Spring soap pica. J Emerg Nurs 2017; 43(3): 281-3.
[http://dx.doi.org/10.1016/j.jen.2017.03.009] [PMID: 28476302]
[15]
Epler KE, Pierce A, Rappaport VJ. Pica in pregnancy: An unusual presentation. Obstet Gynecol 2017; 130(6): 1377-9.
[http://dx.doi.org/10.1097/AOG.0000000000002365] [PMID: 29112667]
[16]
Liu YH, Pesch MH, Lumeng JC, Stein MT. Pica in a four-year-old girl with global developmental delay. J Dev Behav Pediatr 2015; 36(9): 758-60.
[http://dx.doi.org/10.1097/DBP.0000000000000228] [PMID: 26468937]
[17]
Matson JL, Hattier MA, Belva B, Matson ML. Pica in persons with developmental disabilities: approaches to treatment. Res Dev Disabil 2013; 34(9): 2564-71.
[http://dx.doi.org/10.1016/j.ridd.2013.05.018] [PMID: 23747942]
[18]
Tokue H, Takahashi Y, Hirasawa S, et al. Intestinal obstruction in a mentally retarded patient due to pica. Ann Gen Psychiatry 2015; 14: 22.
[http://dx.doi.org/10.1186/s12991-015-0060-4] [PMID: 26236386]
[19]
Rangwala SD, Tobin MK, Birk DM, Butts JT, Nikas DC, Hahn YS. Pica in a child with anterior cingulate gyrus oligodendroglioma: Case report. Pediatr Neurosurg 2017; 52(4): 279-83.
[http://dx.doi.org/10.1159/000477816] [PMID: 28704833]
[20]
Bharti A, Mishra AK, Sinha V, Anwar Z, Kumar V, Mitra S. Paper eating: An unusual obsessive-compulsive disorder dimension. Ind Psychiatry J 2015; 24(2): 189-91.
[http://dx.doi.org/10.4103/0972-6748.181713] [PMID: 27212826]
[21]
Fotoulaki M, Panagopoulou P, Efstratiou I, Nousia-Arvanitakis S. Pitfalls in the approach to pica. Eur J Pediatr 2007; 166(6): 623-4.
[http://dx.doi.org/10.1007/s00431-006-0282-1] [PMID: 17008997]
[22]
Hergüner S, Hergüner AS. Pica in a child with attention deficit hyperactivity disorder and successful treatment with methylphenidate. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34(6): 1155-6.
[http://dx.doi.org/10.1016/j.pnpbp.2010.06.005] [PMID: 20547198]
[23]
Hergüner A, Hergüner S. Pica in an adolescent with autism spectrum disorder responsive to aripiprazole. J Child Adolesc Psychopharmacol 2016; 26(1): 80-1.
[http://dx.doi.org/10.1089/cap.2015.0184] [PMID: 26780755]
[24]
Leung AK, Hon KL. Attention-deficit/hyperactivity disorder. Adv Pediatr 2016; 63(1): 255-80.
[http://dx.doi.org/10.1016/j.yapd.2016.04.017] [PMID: 27426904]
[25]
Barton JC, Barton JC, Bertoli LF. Pica associated with iron deficiency or depletion: clinical and laboratory correlates in 262 non-pregnant adult outpatients. BMC Blood Disord 2010; 10: 9.
[PMID: 21176208]
[26]
Frey M, Overmann KM, Richert A, Kerrey BT. A toddler with severe anemia, pica, and extremity swelling. J Emerg Nurs 2017; 43(6): 578-80.
[http://dx.doi.org/10.1016/j.jen.2016.08.013] [PMID: 28343690]
[27]
Aparna PV, Austin RD, Mathew P. PICA. Indian J Dent Res 2012; 23(3): 426-7.
[http://dx.doi.org/10.4103/0970-9290.102246] [PMID: 23059587]
[28]
Advani S, Kochhar G, Chachra S, Dhawan P. Eating everything except food (PICA): A rare case report and review. J Int Soc Prev Community Dent 2014; 4(1): 1-4.
[http://dx.doi.org/10.4103/2231-0762.127851] [PMID: 24818086]
[29]
Aloni MN, Lecerf P, Lê PQ, et al. Is Pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort. Hematology 2015; 20(7): 429-32.
[http://dx.doi.org/10.1179/1607845414Y.0000000219] [PMID: 25494639]
[30]
O’Callaghan ET, Gold JI. Pica in children with sickle cell disease: two case reports. J Pediatr Nurs 2012; 27(6): e65-70.
[http://dx.doi.org/10.1016/j.pedn.2012.07.012] [PMID: 22917881]
[31]
Rose EA, Porcerelli JH, Neale AV. Pica: common but commonly missed. J Am Board Fam Pract 2000; 13(5): 353-8.
[PMID: 11001006]
[32]
Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status. Am J Hum Biol 2015; 27(1): 84-93.
[http://dx.doi.org/10.1002/ajhb.22598] [PMID: 25156147]
[33]
Chawla N, Mandal P, Chatterjee B, Dhawan A. Tramadol-associated pica. Psychiatry Clin Neurosci 2019; 73(1): 43.
[http://dx.doi.org/10.1111/pcn.12789] [PMID: 30367530]
[34]
Yamamoto K, Yamatodani A. Strain differences in the development of cisplatin-induced pica behavior in mice. J Pharmacol Toxicol Methods 2018; 91: 66-71.
[http://dx.doi.org/10.1016/j.vascn.2018.01.559] [PMID: 29407728]
[35]
Barton JC, Barton JC, Bertoli LF. Pica for uncooked Basmati rice in two women with iron deficiency and a review of ryzophagia. Case Rep Med 2016.8159302
[http://dx.doi.org/10.1155/2016/8159302] [PMID: 26880930]
[36]
Bhatia MS, Kaur N. Pagophagia - a common but rarely reported form of pica. J Clin Diagn Res 2014; 8(1): 195-6.
[http://dx.doi.org/10.7860/JCDR/2014/6829.3959] [PMID: 24596772]
[37]
Bhatti S, Malik AA, Rafaqat M, Ishaque U, Ayyaz M. Acuphagia as a cause of gastric bezoar causing gastric outlet obstruction. J Coll Physicians Surg Pak 2014; 24(Suppl. 3): S190-2.
[PMID: 25518769]
[38]
Boybeyi O, Albayrak M, Aslan MK, Soyer T. Colonic lithobezoar: a rare cause of partial intestinal obstruction. Turk J Pediatr 2013; 55(1): 104-6.
[PMID: 23692843]
[39]
Devasahayam J, Pillai U, Lacasse A. Talcum powder pica as the cause of interstitial lung disease. QJM 2012; 105(8): 795-7.
[http://dx.doi.org/10.1093/qjmed/hcr106] [PMID: 21764811]
[40]
Gerrits EG, Schnog JB. An unusual craving! Neth J Med 2015; 73(2): 96.
[PMID: 25753078]
[41]
Gowda M, Patel BM, Preeti S, Chandrasekar M. An unusual case of xylophagia (paper-eating). Ind Psychiatry J 2014; 23(1): 65-7.
[http://dx.doi.org/10.4103/0972-6748.144972] [PMID: 25535449]
[42]
Iyasere O, Allington Y, Cafferkey M. Polyurethane foam pica in a patient with excessive interdialytic weight gain. BMJ Case Rep 2010; 2010: 2826.
[http://dx.doi.org/10.1136/bcr.03.2010.2826] [PMID: 22767521]
[43]
Kalgaonkar SR, Ramakantan R. Pica and the radiologist - beyond the radiology report digging deeper. Indian J Radiol Imaging 2018; 28(3): 330-2.
[http://dx.doi.org/10.4103/ijri.IJRI_48_18] [PMID: 30319211]
[44]
Kariholu PL, Jakareddy R, Hemanthkumar M, Paramesh KN, Pavankumar NP. Pica - a case of acuphagia or hyalophagia? Indian J Surg 2008; 70(3): 144-6.
[http://dx.doi.org/10.1007/s12262-008-0040-x] [PMID: 23133044]
[45]
Kırpınar I, Kocacenk T, Koçer E, Memmi N. Recurrent trichobezoar due to trichophagia: a case report. Gen Hosp Psychiatry 2013; 35(4): 439-41.
[http://dx.doi.org/10.1016/j.genhosppsych.2013.01.013] [PMID: 23541805]
[46]
Kumsar NA, Erol A. The behavior of eating glass, with radiological findings: a case of pica. J Neuropsychiatry Clin Neurosci 2013; 25(2): E46-8.
[http://dx.doi.org/10.1176/appi.neuropsych.12040090] [PMID: 23686062]
[47]
Rogers B, Kramer J, Smith S, Bird V, Rosenberg EI. Sodium chloride pica causing recurrent nephrolithiasis in a patient with iron deficiency anemia: a case report. J Med Case Reports 2017; 11(1): 325.
[http://dx.doi.org/10.1186/s13256-017-1499-5] [PMID: 29149910]
[48]
Shahryar M, Shahramian I, Dehghani SM, Noori N, Ataollahi M. Lithophagia as a clue for celiac disease: a case report and literature review. Gastroenterol Hepatol Bed Bench 2017; 10(1): 70-2.
[PMID: 28331568]
[49]
Spaniolas K, Ou S, Findeis-Hosey J, Monson JR, Salloum R. Paper pica: an unusual cause of colonic ischemia. J Gastrointest Surg 2010; 14(6): 1065-6.
[http://dx.doi.org/10.1007/s11605-009-1092-3] [PMID: 19936850]
[50]
Tazi I, Nafil H, Mahmal L. Sponge eating: an unusual cause of severe anemia. Hematol Oncol Stem Cell Ther 2012; 5(2): 125.
[http://dx.doi.org/10.5144/1658-3876.2012.125] [PMID: 22828379]
[51]
von Garnier C, Stünitz H, Decker M, Battegay E, Zeller A. Pica and refractory iron deficiency anaemia: a case report. J Med Case Reports 2008; 2: 324.
[http://dx.doi.org/10.1186/1752-1947-2-324] [PMID: 18838005]
[52]
Beck DA, Frohberg NR. Coprophagia in an elderly man: a case report and review of the literature. Int J Psychiatry Med 2005; 35(4): 417-27.
[http://dx.doi.org/10.2190/6EWR-M247-4W17-HNK1] [PMID: 16673841]
[53]
Sharma TR, Kavuru B, Aly M. Coprophagia and pica in individuals with mild to moderate dementia and mixed (iron deficiency and macrocytic) anemia. J Am Geriatr Soc 2011; 59(12): 2375-7.
[http://dx.doi.org/10.1111/j.1532-5415.2011.03703.x] [PMID: 22188083]
[54]
Starn AL, Udall JN Jr. Iron deficiency anemia, pica, and restless legs syndrome in a teenage girl. Clin Pediatr (Phila) 2008; 47(1): 83-5.
[http://dx.doi.org/10.1177/0009922807303930] [PMID: 17641119]
[55]
Chatzimavroudis G, Christopoulos P, Atmatzidis S, et al. Pica: an uncommon cause of acute abdominal pain in children. Indian J Pediatr 2011; 78(7): 886-7.
[http://dx.doi.org/10.1007/s12098-011-0376-2] [PMID: 21328077]
[56]
Sabouraud S, Testud F, Descotes J, Benevent M, Soglu G. Lead poisoning following ingestion of pieces of lead roofing plates: pica-like behavior in an adult. Clin Toxicol (Phila) 2008; 46(3): 267-9.
[http://dx.doi.org/10.1080/15563650701639014] [PMID: 17906991]
[57]
Hon KL, Fung CK, Leung AK. Childhood lead poisoning: an overview. Hong Kong Med J 2017; 23(6): 616-21.
[PMID: 29026055]
[58]
Akbar S, Akbar L, Akbar N, Nawras A. Trichobezoar-induced heartburn in a teenage girl: A case report. J Investig Med High Impact Case Rep 2018.62324709618776345
[http://dx.doi.org/10.1177/2324709618776345] [PMID: 29796396]
[59]
Hon KL, Cheng J, Chow CM, et al. Complications of bezoar in children: what is new? Case Rep Pediatr 2013.2013523569
[PMID: 24288642]
[60]
Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.
[61]
Islek A, Sayar E, Yılmaz A, Boneval C, Artan R. A rare outcome of iron deficiency and pica: Rapunzel syndrome in a 5-year-old child iron deficiency and pica. Turk J Gastroenterol 2014; 25(1): 100-2.
[http://dx.doi.org/10.5152/tjg.2014.4051] [PMID: 24918141]
[62]
Roy A, Fuentes-Afflick E, Fernald LCH, Young SL. Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite 2018; 120: 163-70.
[http://dx.doi.org/10.1016/j.appet.2017.08.033] [PMID: 28864256]
[63]
Hunt MG, Belfer S, Atuahene B. Pagophagia improves neuropsychological processing speed in iron-deficiency anemia. Med Hypotheses 2014; 83(4): 473-6.
[http://dx.doi.org/10.1016/j.mehy.2014.07.016] [PMID: 25169035]
[64]
Howarth D. Pica -- a case report. Aust Fam Physician 2013; 42(5): 299-300.
[PMID: 23781529]
[65]
Talbot A, Lippiatt C, Tantry A. Lead in a case of encephalopathy. BMJ Case Rep 2018 Mar 9; 2018.
[http://dx.doi.org/10.1136/bcr-2017-222388]
[66]
Hauptman M, Bruccoleri R, Woolf AD. An update on childhood lead poisoning. Clin Pediatr Emerg Med 2017; 18(3): 181-92.
[http://dx.doi.org/10.1016/j.cpem.2017.07.010] [PMID: 29056870]
[67]
Leung AK, Chan KW. Iron deficiency anemia. Adv Pediatr 2001; 48: 385-408.
[PMID: 11480764]
[68]
Tucker MH, Holmes J, Harley S, Garcia MR, Custodio H. Case 1: Fever and ataxia in a toddler with pica. Pediatr Rev 2017; 38(9): 435-6.
[http://dx.doi.org/10.1542/pir.2016-0189] [PMID: 28864734]
[69]
Sahai S, Sahai A. Pica causing neurocysticercosis in pregnancy presenting as eclampsia: a report of two cases. J Obstet Gynaecol India 2013; 63(1): 68-9.
[http://dx.doi.org/10.1007/s13224-012-0139-7] [PMID: 24431605]
[70]
Barker D. Tooth wear as a result of pica. Br Dent J 2005; 199(5): 271-3.
[http://dx.doi.org/10.1038/sj.bdj.4812651] [PMID: 16155537]
[71]
Toker H, Ozdemir H, Ozan F, et al. Dramatic oral findings belonging to a pica patient: a case report. Int Dent J 2009; 59(1): 26-30.
[PMID: 19323308]
[72]
Decaudin P, Kanagaratnam L, Kmiec I, et al. Prevalence of geophagy and knowledge about its health effects among native Sub-Saharan Africa, Caribbean and South America healthy adults living in France. Eat Weight Disord 2018. Epub ahead of print
[http://dx.doi.org/10.1007/s40519-018-0624-9] [PMID: 30547293]
[73]
Ibrahim OR, Lugga AS, Ibrahim N, Ibrahim LM, Suleiman BM. Iron-deficiency anemia with lithobezoar (pica): a rare cause of intestinal obstruction in a 5-year-old Nigerian child. Int Med Case Rep J 2018; 11: 225-8.
[http://dx.doi.org/10.2147/IMCRJ.S175653] [PMID: 30271221]
[74]
Kim S, Qureshi F. Images in emergency medicine. Small-bowel obstruction as a result of sand pica. Ann Emerg Med 2007; 49(3): 378-86.
[http://dx.doi.org/10.1016/j.annemergmed.2006.06.004]
[75]
Solaini L, Gardani M, Ragni F. Geophagia: An extraordinary cause of perforation of the sigmoid colon. Surgery 2012; 152(1): 136-7.
[http://dx.doi.org/10.1016/j.surg.2011.06.033] [PMID: 21943632]
[76]
Sekiya K, Mori S, Otomo Y. Coin pica-induced gastric perforation resulting from ingestion of 1,894 coins, 8 kg in total: case report and review of published works. Acute Med Surg 2017; 5(2): 177-80.
[http://dx.doi.org/10.1002/ams2.318] [PMID: 29657731]
[77]
Byard RW. A review of the forensic implications of pica. J Forensic Sci 2014; 59(5): 1413-6.
[http://dx.doi.org/10.1111/1556-4029.12520] [PMID: 24975510]
[78]
Loots DP, du Toit-Prinsloo L. A fatal outcome of pica. Forensic Sci Med Pathol 2016; 12(1): 108-12.
[http://dx.doi.org/10.1007/s12024-015-9741-1] [PMID: 26767829]
[79]
Hagopian LP, Rooker GW, Rolider NU. Identifying empirically supported treatments for pica in individuals with intellectual disabilities. Res Dev Disabil 2011; 32(6): 2114-20.
[http://dx.doi.org/10.1016/j.ridd.2011.07.042] [PMID: 21862281]

© 2024 Bentham Science Publishers | Privacy Policy