[Pica and iron deficiency in adolescence]

Pica is a habit disorder involving the compulsive, irrational ingestion of nutrient or non-nutrient substances which usually, in young infants, include clay and earth. Pica is rare in adolescents but is more likely to occur in subjects with severe iron deficiency.

17 (16 girls, 1 boy) cases of pica were recognized over a period of 4 years in an adolescent unit. 15 of the cases presented with anemia and/or iron deficiency. Hematological and biochemical investigations included measurements of hemoglobin content, MCV, serum iron and ferritin, transferrin saturation and serum iron-binding capacity. Blood loss was considered as a possible cause in all patients.

13 of the patients ingested large amounts of raw rice and 11 ingested ice cubes; 10 patients ingested both substances. Their mean serum ferritin was 7.17 ng/ml and the mean hemoglobin was 8.7 g/dl. One out of 7 patients showed intestinal blood loss. Excessive menstrual bleeding occurred in 8 girls. All patients were treated with adequate amounts of iron. Pica disappeared within a few weeks, although biochemical evidence of iron deficiency persisted in some patients. In one case, pica persisted despite correction of the iron deficiency.

Pica is more prevalent in lower socio-economic classes and in some areas, such as the island of Reunion. It may be masked, and must be looked for in adolescents presenting with signs of iron deficiency. Treatment of the iron deficiency is usually followed by its disappearance.