Q: My 4-year-old son, who has been diagnosed with autism, eats inappropriate things like dirt and chalk. My neighbor says he might have pica. What is that?
A: The word “pica” comes from the Latin word for magpie, a bird known to eat both food and nonfood items. Pica is defined as the ingestion of nonnutritive substances such as dirt, paint, or clay.
“Pica is one of the most common types of eating disorders exhibited by individuals with developmental disabilities such as autism and mental retardation,” explains Jennifer Bass, Psy.D., Director of Curriculum Development at the May Center for Child Development in Randolph, Mass.
“Various studies have indicated that pica may be demonstrated by as many as 25 percent of individuals with developmental disabilities, and that this may be a conservative estimate. Individuals with brain injury or epilepsy and women who are pregnant may also develop pica,” Dr. Bass said.
Children younger than 2 years of age often put non-food items in their mouths as a way of exploring objects. This behavior is a normal part of healthy development. If a child continues to eat non-food items after age 2 despite consistent efforts to stop the behavior, parents should consult with a medical or mental health professional, as pica may be indicated.
Some of the non-food items that people with pica consume include dirt, clay, sand, paint chips, plaster, chalk, string, cornstarch and laundry starch, baking soda, coffee grounds, cigarette ashes, cigarette butts, burnt match heads, feces and animal droppings, glue, hair, buttons, paper, insects, nails, and coins.
Although some of these items are harmless, some, such as lead-based paint chips, are dangerous and can cause lead poisoning. In addition, some may introduce life-threatening choking hazards.
Individuals with pica may be at risk for other serious health problems including bowel problems (from consuming indigestible substances like hair), dental injury (from eating hard items like buttons), intestinal obstruction or perforation (from eating objects that could get lodged in the intestines), and parasitic infections (from eating dirt or feces).
Some factors related to pica include iron-deficiency anemia and vitamin or mineral deficiencies; developmental disabilities; lack of ability to discriminate between edible and non-edible items; environmental factors such as stressful events and impoverished environments; and mental health conditions such as obsessive-compulsive disorder (OCD), anxiety, depression, and schizophrenia.
Teachers at a May Institute school for children with autism and other developmental disabilities developed and implemented a successful intervention for a 5-year-old boy with autism who had a history of pica behavior. Each time the boy displayed pica behavior, a teacher interrupted the behavior and prompted him to throw the object away.
This intervention was repeated ten times following each pica incident. Described as “contingent practice,” this intervention was effective in reducing, and essentially eliminating pica in this case.
“The health risks and the possible stigma associated with pica demand intensive intervention. Ensuring the safety of the individual with pica is vital,” said Dr. Bass. “Parents who suspect that their child may have pica should enlist the help of knowledgeable medical and mental health professionals for appropriate assessment and treatment. These professionals can help develop an individualized treatment plan that can be implemented wherever the child spends time including school, home, and the community.”
May Institute is a national nonprofit organization that provides educational, rehabilitative, and behavioral healthcare services to individuals with special needs. The Institute provides consultation to schools and families, and emotional and psychological services to individuals at counseling centers in Walpole and West Roxbury. May also operates schools for children and adolescents with autism spectrum disorders, and other developmental disabilities in Randolph, West Springfield, and Woburn, Mass., and Santa Cruz, Calif. For more information, contact May Institute at 800-778-7601 or visit www.mayinstitute.org.
