Pica resident survival guide
|Pica Resident Survival Guide Microchapters|
Synonyms and keywords: Approach to pica, Pica workup, Pica management
Pica is defined as the compulsive craving for or eating non-nutritive or non-food substances for at least a period of one month. Pica may be a part of a cultural phenomenon, during childhood, in persons or children who are mentally disabled or even in pregnancy. Iron deficiency anemia is also an important cause of pica. Pica is treated by a multifocal approach which includes reduction of cravings, addressing the social and emotional issues faced by the individual and treating the anemia if present. Pica is further divided based on the type of substance ingested such as ice, lead, soil, etc.
- Pica is commonly seen in children over 2 years of age.
- Iron deficiency anemia
- Autism and other developmental disabilities
- Lower socioeconomic status
- Recently, obsessive compulsive disorder has also been implicated as a cause .
- The diagnosis of pica includes a detailed history and physical examination, appropriate laboratory investigations.
Obtain a detailed history:
❑ Duration of symptoms
❑ What is the substance being ingested?
❑ When does the patient exhibit this behaviour?
❑ Is it during periods of emotional or physical stress?
What is the source of the substance?
According to the DSM5, the following 5 criteria must be met to diagnose someone with pica:
❑ Person must be eating non-nutritive or non-food substances for at least one month.
❑ This behaviour must be considered abnormal for their stage of development.
❑ This behaviour must not be considered as a part of a cultural practice, and should be normal in the social context of that person.
❑ For a person with an existing condition like mental disability or pregnancy, this behaviour
is considered as pica only when it is dangerous or requires medical investigations and attention.
While physical examination might be unrevealing in most cases, importance must be given to elicit
signs and symptoms of possible poisoning or other complications such as the following:
❑ Signs of lead ingestion
* Kidney failure in chronic ingestion
❑ Signs of parasitic infestation
❑ Signs of bezoar ingestion
* Pain per abdomen
* Gastrointestinal obstruction and
|Iron deficiency anemia||Pregnancy||Pica in children||Differential diagnoses|
Management of pica is summarised in the algorithm below.
|Comprehensive history, physical examination and laboratory investigations|
|Treatment of iron deficiency anemia||Treatment of pica in pregnancy||Treating pica in childhood|
- Check for lead levels in children with pica, particularly those living in houses built during and before 1960.
- Screen for parasitic infections such as Toxocara and Ascaris in people exhibiting geophagia (ingestion of soil, sand or clay).
- Basic metabolic tests should be done, particularly when hypokalemia is suspected as it is seen in people ingesting clay or chalk.
- Rule out substance abuse in adults with pica.
- Don't forget to educate patients about healthy eating habits.
- Don't make a diagnosis of pica where cultural traditions such as clay eating are normative.
- Fawcett EJ, Fawcett JM, Mazmanian D (2016). "A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period". Int J Gynaecol Obstet. 133 (3): 277–83. doi:10.1016/j.ijgo.2015.10.012. PMID 26892693.
- Geissler PW, Prince RJ, Levene M, Poda C, Beckerleg SE, Mutemi W; et al. (1999). "Perceptions of soil-eating and anaemia among pregnant women on the Kenyan coast". Soc Sci Med. 48 (8): 1069–79. doi:10.1016/s0277-9536(98)00409-2. PMID 10390045.
- Leung AKC, Hon KL (2019). "Pica: A Common Condition that is Commonly Missed - An Update Review". Curr Pediatr Rev. 15 (3): 164–169. doi:10.2174/1573396315666190313163530. PMID 30868957.
- Hergüner S, Ozyildirim I, Tanidir C (2008). "Is Pica an eating disorder or an obsessive-compulsive spectrum disorder?". Prog Neuropsychopharmacol Biol Psychiatry. 32 (8): 2010–1. doi:10.1016/j.pnpbp.2008.09.011. PMID 18848964.
- Hoek HW, van Elburg AA (2014). "[Feeding and eating disorders in the DSM-5]". Tijdschr Psychiatr. 56 (3): 187–91. PMID 24643829.
- Woodhall DM, Garcia AP, Shapiro CA, Wray SL, Shane AL, Mani CS; et al. (2017). "Assessment of U.S. Pediatrician Knowledge of Toxocariasis". Am J Trop Med Hyg. 97 (4): 1243–1246. doi:10.4269/ajtmh.17-0232. PMC 5637614. PMID 28820703.