Pica: what it is, causes, and when to get help

Pica is a feeding disorder in which someone eats things that are not food and have no nutritional value. Beat gives paper, soap, paint, chalk and ice as examples. Tommy’s adds clay or dirt, stones, charcoal and pieces of paper when describing cravings for non-food items in pregnancy.

For a diagnosis of pica the behaviour must be present for at least one month, must not be part of a cultural practice and must be developmentally inappropriate. Beat says it is not generally diagnosed in children under the age of two, as it is common for babies to mouth objects, which can lead them to accidentally eat things that are not meant to be eaten.

Beat also explains that pica is often not revealed until medical consequences occur, such as metal toxicity, cracked teeth or infections. People with pica do not usually avoid regular food, so they may still be getting the nutrients they need, but some of the items eaten can be very dangerous, especially in large amounts.

Beat lists the signs of pica as follows.

• Craving to consume substances that are not supposed to be eaten.

• Eating substances that are not supposed to be eaten.

• Physical illness as a result of eating harmful substances, for example poisoning, nutritional deficiencies, infection, poor oral health and intestinal obstruction.

Beat says the exact reasons people develop pica are not yet clear, and that the proportion of people who have it is not known because researchers use different definitions. Research suggests several contributing factors, including genes, the environment and psychology.

Two explanations Beat gives are sensory or emotional regulation, for example to manage difficult emotions or to provide sensory feedback, and mineral or vitamin deficiencies. Pica has been linked with iron or ferritin deficiency, and in some people the behaviour improves once the deficiency is corrected. Not everyone with pica is deficient, and it is unclear whether the deficiency causes the behaviour or the other way around.

The NHS lists wanting to eat non-food items, such as paper or ice, among the less common symptoms of iron deficiency anaemia. The more usual symptoms are tiredness and lack of energy, shortness of breath, noticeable heartbeats, paler than usual skin and headaches.

If you think you might have iron deficiency anaemia, the NHS says to see a GP, who will usually arrange a blood test called a full blood count. Once the reason for the anaemia has been found, the GP will recommend treatment. If the red blood cell count is low, iron tablets are recommended, taken for about 6 months, and repeat blood tests check that your iron level returns to normal.

The NHS says heavy periods and pregnancy are very common causes of iron deficiency anaemia, and bleeding in the stomach and intestines is another. It also says to keep iron tablets out of the reach of children, because an overdose of iron in a young child can be fatal.

Cravings for certain foods are common in pregnancy and are usually nothing to worry about. Tommy’s says they probably start at the end of the first trimester, get stronger in the second and usually go away by the third. The cravings that need attention are those for things that are not food.

Tommy’s says to contact your GP or midwife if you crave non-food items, because you may have pica, which can be caused by an iron deficiency and can be a sign of severe anaemia. The NHS Start for Life pregnancy guide gives the same advice: if you have unusual cravings, like wanting to eat dirt, talk to your midwife or doctor. Tommy’s adds that eating these items can be harmful, and that anyone who has eaten something not meant to be eaten should get medical help immediately.

Beat says pica is more likely to first appear among children, but that it is not generally diagnosed before the age of two because mouthing objects is normal at that age. Beat also warns that some non-food items eaten can be very dangerous, especially in large amounts.

If you are worried about a child, see a GP as soon as possible, as Beat advises. If a child has eaten something that is not supposed to be eaten, Beat says to seek medical help immediately and that it may be necessary to contact the emergency services. Describe what was swallowed and when, if you know.

Beat says treatment depends on the individual needs, the severity and the underlying cause, and that a multidisciplinary, tailored approach should be taken. It may include the following.

• Addressing nutritional deficiencies, for example with supplementation.

• Behavioural therapies, which can include promoting self-soothing behaviour, redirecting attention, managing anxieties and replacing pica items with similar but safe alternatives.

• Medical intervention where the behaviour has led to physical health problems.

• Medication, which may be offered.

• Addressing underlying conditions such as obsessive-compulsive disorder, depression or schizophrenia.

Beat says that if you or someone you know has eaten something that is not supposed to be eaten, you should seek medical help immediately, and that it may be necessary to contact the emergency services. If you cannot tell how dangerous the item is, NHS 111 can advise, and in an emergency call 999.

For concern without an emergency, see a GP. Beat says if you are worried about yourself or someone else you should visit your doctor as soon as possible so that you can get the right treatment and support. Tell them what is being eaten, how often and for how long, because this helps them decide which tests are needed.

On the NHS the first step is usually a GP, who can arrange blood tests for iron deficiency anaemia and, if needed, refer to mental health, paediatric or eating disorder services. During pregnancy, your midwife is also a route in.

Private GP, paediatric and psychology services can offer similar assessments, often with shorter waits. Treatment is tailored, so ask who will co-ordinate care between the medical, nutritional and psychological parts of support.