Information on the following diseases can be found in the Related Disorders section of this report:

• None

Onset of pica generally occurs when the affected individual is between 12 and 24 months of age. Affected infants typically eat paint, plaster, string, hair or cloth. Older children may eat substances such as animal droppings, sand, bugs, leaves or pebbles. Aversion to food is absent. Complications of the disorder are lead poisoning (from eating lead- based paints) and hairball tumors. Non-food items such as laundry starch, clay, dirt, stones, chalk and limestone are other substances that may be craved by pica patients. Children usually outgrow pica. Rarely, adults may manifest the disorder. Pregnant women sometimes have a craving for unusual foods like pickles or ice, but rarely for non-food items.

While a relationship between pica and iron deficiency has been suggested, a cause and effect relationship has not yet been proven. Some substances which are craved by patients with this disorder interfere with the body's absorption of iron from food. Some authorities believe that pica is a learned pattern of behavior while others theorize that it is due to other cultural, psychological and physiological factors or a combination of these factors. In many cases, correction of iron or other deficiencies in the patient may eliminate the abnormal craving that characterizes this disorder.

Pica can begin as early as the age of one year. It is usually outgrown by six or seven years of age, but some cases persist until puberty. Some adult women, particularly pregnant women, can suffer from this disorder. Severely retarded people often must be monitored to protect them from eating non-edible substances. Pica is thought to be underreported, and the prevalence is not known with any accuracy. It is considered "developmentally inappropriate" in children older than 18 to 24 months.

Treatment of Pica mainly consists of preventing patients from eating the craved, non-nutritive substances. Psychiatric counseling aimed at behavior modification is often recommended. However, for certain cultural reasons, some Pica clay and starch eaters may persist in occasionally eating a lump or two of these items.

When mineral imbalances can be identified in people who have Pica, the imbalance should be corrected with vitamin and/or mineral supplements. In many cases correction of these deficiencies will stop or reduce the craving for inedible substances.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, go to:
www.centerwatch.com

TEXTBOOKS
Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:858; 2022.

Berkow R, ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:907; 1440.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill Companies. New York, NY; 1998:1164.

FROM THE INTERNET
Pica: Medical Encyclopedia. MedlinePlus. Update Date: 5/4/2004. 2pp
www.nlm.nih.gov/medlineplus/ency/article/001538.htm

Gavin ML, Homeier BP. Pica. KidsHealth. Nemours Foundation. Date reviewed: December 2004. 4pp.
http://kidshealth.org/parent/emotions/behavior/pica.html

Ellis CR, Schnoes CJ. Eating Disorder: Pica. emedicine. Last Updated: September 10, 2002. 10pp.
www.emedicine.com/ped/topic1798.htm