Alexander K.C. Leung* and Kam Lun Hon Pages 164 - 169 ( 6 )
Background: Pica is a common condition in childhood that is commonly missed.
Objective: To familiarize physicians with the clinical evaluation and management of children with pica.
Methods: A PubMed search was completed in Clinical Queries using the key term "pica" OR “dirteating”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
Results: Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual’s emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.
Conclusion: Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.
Pica, anemia, lead poisoning, malnutrition, mental retardation, dirt-eating.
Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, AB, Department of Paediatrics, The Chinese University of Hong Kong, Shatin