The term is derived from "pica-pica," the Latin word for the magpie bird, because of the bird's indiscriminate gathering and eating a variety of objects for the sake of curiosity. However, if there is a palpable mass or signs of obstruction, a contrast study or CT are the investigations of choice.The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as eating nonnutritive, nonfood substances over a period of at least one month. Plain film of the abdomen may show signs suggestive of trichophagia. Imaging studies may be useful if there is a suspicion that abrasive objects have been ingested or there are clinical signs of gastrointestinal obstruction. 14 Consider checking at least urea and electrolytes, liver function tests, calcium, phosphate magnesium and trace elements in these children. There is little evidence to suggest an ideal set of investigations in children presenting with faltering growth. When environmental exposure is suspected. With a history of ingestion of lead based paints With signs or symptoms of poisoning ( figure 1) 13 Check blood lead concentration in children: However, it is still common in older houses, and knowledge of the local environment is important. 10 The prevalence of lead piping in domestic water supplies in the UK has decreased significantly in recent years. The American Academy of Pediatrics recommends that routine screening of blood lead concentrations be performed in children who live in residential areas where at least 27% of the houses were built before 1950. 6 Check a full-blood picture and iron studies in all children.įurther investigations should be tailored according to the substance ingested and the clinical findings. The meta-analysis examining micronutrient status and pica noted a strong association between pica and anaemia. Investigations may be useful in screening for potential causes and complications. Pica is a clinical diagnosis based on the DSM-V diagnostic criteria. Recent literature, for example, has highlighted concerns regarding the increased incidence of pica among children with sickle cell disease. 2 It may present in the presence of a coexisting psychiatric disorder, and there is increasing evidence that it may be associated with conditions leading to malabsorption, poor nutritional status or anaemia. Pica in children has also been associated with deprivation, parental neglect and malnutrition. However, current thinking suggests that this is more likely to be secondary to learned behaviours. The higher incidence of pica noted in children with learning and developmental disabilities, including autistic spectrum disorder, was traditionally believed to result from an inability to differentiate between food and non-food items. However, there has been limited success in preventing pica in cases where nutritional deficiencies have been identified and treated. 6 Children with pica may ingest substances rich in the nutrients in which they are deficient. A recent meta-analysis confirmed the association between anaemia, low plasma zinc levels and pica. Proposed mechanisms range from psychosocial to biochemical.Īn association between pica and micronutrient deficiencies, including iron, calcium and zinc has been well described. The aetiology of pica is poorly understood and is probably multifactorial. 3 Although often described as pica in the literature, these practices may actually be deemed to be socially normative practice and therefore do not fit the diagnostic criteria outlined in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Geophagia, including the ingestion of kaolin (white clay), is seen in sections of the African-American population in the USA and is common practice in parts of Africa. Ingestion of non-food substances may also be associated with cultural practices. Pica can be classified according to the particular substance ingested. If the behaviour occurs within the context of another mental disorder or medical condition, it is sufficiently severe to warrant independent clinical attention. The eating behaviour is not part of a culturally supported or socially normative practice. The eating of such substances is inappropriate to the developmental level of the individual. The eating of non-nutritive, non-food substances is persistent over a period of at least 1 month. Box 1 DSM-V ( The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria for the diagnosis of pica
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