My son eats dirt. Does he have a disorder?

Pica is a childhood eating disorder. The term "pica" comes from Latin and refers to the magpie, a bird in the crow family known for its voracious appetite and for eating a wide range of non-food items.

Pica is characterized by the compulsive and persistent consumption—that is, not sporadic—of non-nutritive and inedible substances. To be considered pica, this consumption must occur for at least one month .

Materials commonly ingested that are associated with pica include, among others:

• Chalk
• Clothes
• Land
• Hair
• Paper
• Stones
• Shampoo

Many young children put objects in their mouths. This is common behavior in the first few months of life and is part of the process of exploring their environment during the first two years. This behavior is considered abnormal after 18-24 months of age, regardless of whether the object is swallowed or not.

The complete causes of the disorder are unknown, but there are some interrelated factors involved in its development:

• Nutritional deficiencies of iron or zinc.
• Sensory stimulation behaviors, such as reinforcement or pleasure derived from sensation , are frequently associated with developmental disorders, autism spectrum disorder, or intellectual disability. Difficulties in understanding and differentiating between edible and non-edible objects are also observed.
• A sociocultural and religious origin . In culture and religion, pica has been passed down from generation to generation in some places and cultures around the world as a medical-magical-religious practice. This behavior has been observed in African culture, among some indigenous tribes, in Latin America, and in Scandinavia, among others.
  

There are few epidemiological studies that allow us to know the prevalence of pica, especially among adults. In the case of children, various studies estimate that pica affects between 10 and 32% of children between the ages of two and six.

Existing studies also agree that this eating disorder is more prevalent in families from low socioeconomic backgrounds. Pica has also been linked to children with global developmental delay, autism, and intellectual disability.

How can I tell if my child has pica?

Pica is diagnosed based on different characteristics or criteria:

• Presence of persistent consumption of one or more non-edible materials for at least one month.
• Presence of physical problems that may be linked to pica: abdominal pain, vomiting, blood in the stool, bowel problems, constipation, and diarrhea.
• When the intake of non-nutritive and non-food substances is inappropriate to the level of development of the person.
• When the behavior is not part of a culturally accepted practice in this person's environment.

How is pica diagnosed?

Once the diagnosis is made, at the pediatrician's discretion, it is advisable to monitor the person's health status since pica can carry various health risks :

• Nutritional problems.
• Electrolyte deficiency, which occurs when the concentration of sodium in the blood is abnormally low.
• Dental erosion, which may include discoloration or wear of the teeth and tooth sensitivity.
• Gastrointestinal complications, such as parasitic infections, constipation, or diarrhea.
• Toxicity.
• Anemia, lack of iron in the blood.

In general, laboratory tests are usually performed to determine the cause of pica, as well as parasitological examinations to minimize physical risks. In some cases, iron replacement therapy is prescribed if anemia is present, or zinc supplementation if low levels of this nutrient are detected. Occasionally, a nutritionist's evaluation is also recommended to understand and address dietary habits, especially in cases of highly selective eating. Furthermore, the therapeutic approach includes a behavioral assessment and intervention to identify pica triggers. Behavioral interventions include environmental control, promotion of alternative coping strategies, promotion of behavior reduction strategies, and differential reinforcement strategies (withholding reinforcement, or extinguishing, inappropriate pica-related behaviors and reinforcing alternative and incompatible behaviors related to the problematic behavior).