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Pica

Geophagy; Lead poisoning - pica

Pica is a pattern of eating non-food materials, such as dirt or paper.

Causes

Pica is seen more in young children than adults. Up to one third of children ages 1 to 6 years have these eating behaviors. It is unclear how many children with pica intentionally consume dirt (geophagy).

Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron and zinc, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

Symptoms

Children and adults with pica may eat:

• Animal feces
• Clay
• Dirt
• Hairballs
• Ice
• Paint
• Sand

This pattern of eating must last for at least 1 month to fit the diagnosis of pica.

Depending on what is being eaten and how much, symptoms of other problems may be present, such as:

• Belly pain, nausea, and bloating caused by blockage in the stomach or intestine
• Fatigue
• Behavior problems, school problems and other findings of lead poisoning or poor nutrition

Exams and Tests

There is no single test for pica. Because pica can occur in people who have certain nutritional deficiencies, your health care provider may test blood levels of iron and zinc.

Blood tests can also be done to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead paint dust to screen for lead poisoning.

Your provider may also test for infection if contaminated soil or animal waste has been eaten.

Treatment

Treatment should first address any missing nutrients or other medical problems, such as lead poisoning.

Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets rewarded for eating normal foods.

Medicines may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability.

Outlook (Prognosis)

Treatment success varies. In many cases, the disorder lasts several months and then disappears on its own. In some cases, it may continue into the teen years or adulthood, especially when it occurs with developmental disorders.

Possible Complications

Complications include:

• Bezoar (a mass of undigestible material trapped inside the body, most often in the stomach)
• Infection

When to Contact a Medical Professional

Contact your provider if you notice that your child (or an adult) is eating nonfood materials.

Prevention

There is no specific prevention. Getting adequate nutrition may help.

Related Information

Iron deficiency anemia
Intestinal obstruction and Ileus
Malnutrition
Lead poisoning

References

DeLoughery TG. Microcytic and hypochromic anemias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 145.

Katzman DK, Norris ML. Feeding and eating disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 9.

Samsel CB, Walter HJ, DeMaso DR. Rumination and pica. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 36.

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Review Date: 5/4/2024  

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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