Pica

What is Pica?

• Pica is an eating disorder of non-nutritive or non-food substances. Pica behaviors may be increased in individuals with autism and can indicate or cause underlying nutrient deficiencies.

• Non-food substances that are often consumed include ice, raw starch, paper, chalk, and more [5]. 

• Pica is different from mouthing behavior seen in young children, but both behaviors may be observed in individuals with autism with greater prevalence [3]. 

• Assessment of pica is not fully established but is primarily based on the history of repeated behavior, stage of development beyond two years of age, and cultural acceptability of consumed items [2, 6]. 

• Pica behavior is more prevalent in children and pregnant women but can be also observed in adults [5]. 

• Nutrient deficiencies, specifically minerals iron and zinc, are observed to be linked with pica.

  • Two suspected reasons include: (1) the ingested non-food items block the gut from absorbing iron and zinc and (2) nutrient deficiencies stimulate the intake of non-food items [5].

Source: Autism Dietitian Instagram

Potential Root Causes

• Mineral deficiencies, namely iron and/or zinc

• Sensory Processing Disorder or certain sensory preferences- may cause the craving of certain tastes or textures

• Poor absorption of nutrients in the gut

• Compulsive or anxiety-related behavior 

• Low intake of iron and zinc-rich foods in the diet

• Anemia

Next Steps

Dietary Considerations for Pica

• Test for possible nutrient and mineral deficiencies

• Increase intake of zinc and iron-rich foods

• Promote gastrointestinal health

Supplement Considerations for Pica

• Trial supplementation with zinc and iron

  • See the iron and zinc notes to learn more about food sources, recommended intakes, and supplements.

Environmental Considerations for Pica

• Living and environmental conditions, such as house paint or dirt, can increase an individual's risk of high lead intake when pica or mouthing behavior is persistent for such non-food items [4, 3].

DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.

Pica & Autism in the Research

Pica Behavior

• While there are not many studies on pica and autism, pica behavior may be seen with greater prevalence and persistence through childhood to adolescence in individuals with autism [3]. 

• Pica may be influenced by compulsive or anxiety-related behaviors but is not described to be a symptom of such disorder diagnoses [7]. 

Sensory Considerations

• Beyond nutritional deficiencies, pica behavior of non-food substances may be sought for their texture, taste, or overall sensation of consumption [1].

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• References

  Description text goes here[1] Ardeshirian KA, Howarth DA. Esperance pica study. Aust Fam Physician. 2017;46(4):243-248.

  [2] Bryant-Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ. Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22. Int J Eat Disord. 2019;52(4):378-387.

  [3] Hauptman M, Woolf AD. Childhood ingestions of environmental toxins: what are the risks? Pediatr Ann. 2017;46(12):e466-e471.

  [4] Hooda PS, Henry CJK, Seyoum TA, Armstrong LDM, Fowler MB. The potential impact of soil ingestion on human mineral nutrition. Science of The Total Environment. 2004;333(1-3):75-87.

  [5] Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status: Pica And Micronutrient Meta-Analysis. Am J Hum Biol. 2015;27(1):84-93.

  [6] NEDA Feeding Hope. (2018, February 22) Pica. National Eating Disorders Association.

  [7] Theravive. (n.d.). Pica DSM-5: Feeding and Eating Disorders.

Authors

Brittyn Coleman, MS, RDN/LD, CLT

Sarah Reale, Dietetics Student