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Published on: August 21, 2015
Fifteen-minute consultation: the child with pica
Ben McNaughten1, Thomas Bourke1, Andrew Thompson1
1Royal Belfast Hospital for Sick Children, Belfast, UK.
Insights
Pica, the persistent eating of non-nutritive substances, commonly affects children and those with learning disabilities. Management requires a multidisciplinary, behavioral approach, as pharmacological options show limited evidence.
Area of Science:
- Pediatrics
- Psychiatry
- Clinical Medicine
Background:
- Pica is defined as persistent ingestion of non-nutritive substances for over one month, occurring at an age where this behavior is inappropriate.
- It is most prevalent in children, individuals with learning disabilities, and during pregnancy.
- The etiology of pica is complex and likely multifactorial, with clinical assessment posing challenges.
Purpose of the Study:
- To define pica and outline its common demographics.
- To discuss the diagnostic challenges and potential life-threatening complications associated with pica.
- To review current management strategies and the evidence base for interventions.
Main Methods:
- Clinical assessment focusing on history and examination tailored to potential complications.
- Review of existing literature on pica etiology, assessment, and management.
- Analysis of the natural course of pica in different populations.
Main Results:
- Pica frequently self-remits in younger children.
- In individuals with learning disabilities, pica can persist into adulthood.
- Complications arising from ingested substances can be life-threatening.
Conclusions:
- Management of pica necessitates a multidisciplinary approach.
- Behavioral interventions are the primary therapeutic strategy.
- There is limited evidence supporting pharmacological interventions, particularly in children.
Abstract:
Pica is defined as the persistent ingestion of non-nutritive substances for more than 1 month at an age at which this behaviour is deemed inappropriate. It occurs most commonly in children, in patients with learning disabilities and in pregnancy. The aetiology of pica is poorly understood and is probably multifactorial. Clinical assessment can be difficult. History and examination should be tailored to address potential complications of the substance being ingested. Complications can be life threatening. Pica often self-remits in younger children. In those with learning disabilities, however, pica may persist into adulthood. Management strategies should involve a multidisciplinary approach, and interventions are primarily behavioural in nature. There is limited evidence to support pharmacological interventions in the management of children with pica.
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