The easiest way to describe PICA is the mouthing or ingestion of non-edible objects past toddler stage of exploring textures. There is a prevalence in institutions of up to 26% of the population from what I can gather. These are usually the DD (Developmentally Delayed) population, autistic or MR. I have also heard numbers of up to 30% of children have this, is that all children? or all DD children? what about adults? although I have read that there is no study conducted in homes to find out what the prevalence is so no data is available. Hmmm. Oh well I can tell you that in my home it’s a pretty high occurrence.
We have 7 autistic children in our home and 3 of them have diagnosed PICA. This is a rather high number of concern to me because that means that a lot of parents are probably dealing with it and it’s still not being talked about a lot. Even one of my higher functioning young boys is a PICA boy. Some of his favorites are drywall, toilet paper, worms and animal hair. (No I don’t define my children by the issues they have it’s just easy to explain this way)
I heard of PICA years ago, and had seen a little over the years but my first real experience was about 6 years ago when a young man came in, pretty much feral if you will. He had torn apart the house, everything off every shelf, all dvd’s tapes and cd’s thrown on the floor and I was punched twice in the face in 5 minutes. This is not an exaggeration, this was actual timing.
He proceeded to put everything he could fit into his mouth into it. Imagine my dismay as he at the age of six reached into his diaper and pulled out a handful to eat (and I’m not talking the diaper)! Paper, tissue, candy wrappers, little plastic toys, hot wheel tires, feces you name it in his mouth it went. and down his throat. Took him outside and we had just mown the grass, there went freshly mown grass in handfuls grabbed up and chewed up and swallowed. Rocks that he could pick up he attempted, by now I knew what to expect, he would attack if you tried to stop him but he needed to know this was not safe. Dirt anything that was different looking to him. He was a little different because he had never been taught not to eat the candy wrappers so we could change some of this. However the grass, dirt, and other stuff we still have to watch.
Our 12-year-old girl came to us at six, with severe PICA and still has it. we have to make sure her room is free of small objects, her toys are only to age 18 months and in the store, I actually tug on eyes and other parts to make sure they don’t come off to see if she can have them. If they come loose in the store, I know it’s a NO! She cannot wear Barrett’s, she will take them out of her hair and swallow them. I have had to talk to the school a few times because there was a paper clip on the outside of her backpack and other things have happened like that. This can be very dangerous as she is non-verbal. There is now a PICA protocol in place at school and anyone who works with her has to be specially trained by the nurse. I have taken her in for ultra sounds and cat scans 3 times due to concerns of PICA and stomach pains. Not sure if she got hold of something when she was out of my home (major concerns were school). When we go to the beach we have to be careful of how much sand she eats. Make sure she does not get blocked up due to the sand then she has it coming out for a week.
Our other guy is only 7. He is picky about food, although he’s changing that but will pick up any little non edible item he can find. A blade of grass, a piece of rock, a piece of wire, you name it, if it’s not food, he likes it. If it is food, eh maybe not!
For these children I can’t set the table with a napkin or put a snack on a paper towel or any kind of paper, the will eat the napkin, paper towel, etc. Last night I was busy talking with the plumber, someone gave dessert to the 7-year-old with a paper towel underneath, so of course cookies were eaten and the paper towel was in the 7 year olds mouth before it got caught that a mistake was made. Oh dear, the life with PICA. Thank goodness only little mistakes get made. It won’t happen again though. It is easy to forget the new one has PICA since he is such a picky eater on his food and we are having to train him to eat all foods. But that is another subject or blog.
One of the favorites is feces, eewww! although it was kind of funny that we have gotten so accustomed to this at this point in time that when we got the paperwork on the newest child reading through the stuff he eats, my daughter said eeww! I asked what part? the feces? she said NO! I get that, he eats LOTION! EEEWWW! I guess it gets into your brain that this is normal for children with PICA to do. We have had quite a few others come through in the intervening years having this issue that this is just NORMAL to us. The precautions you take with different children, as you adjust with any other portion of their disabilities or abilities you adjust to this also.
We buy them chewies to help with the need to chew but that does not take the place of or divert from the fact that we always have to be watchful and waiting for the next thing to pop in their mouth and swallow.
There is a theory that there is a deficiency of vitamins or minerals in their systems of that which they crave. We have had our children checked for all vitamin and mineral deficiencies and no not applicable here so we need to come up with other reasoning. I mean really what on earth could drywall have in it anyway? Bottom line is the children are what they are, they try to eat things not safe and have to be watched vigilantly.
Here is a partial DSM IV explanation for those of you interested:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
307.52 Pica
“The essential feature of Pica is the eating of one or more non-nutritive substances on a persistent basis for a period of at least 1 month (Criterion A). The typical substances ingested tend to vary with age. Infants and younger children typically eat paint, plaster, string, hair, or cloth. Older children may eat animal droppings, sand, insects, leaves, or pebbles. Adolescents and adults may consume clay or soil. There is no aversion to food. This behavior must be developmentally inappropriate (Criterion B) and not part of a culturally sanctioned practice (Criterion C). The eating of non-nutritive substances is an associated feature of other mental disorders (e.g., Pervasive Developmental Disorder, Mental Retardation). If the eating behavior occurs exclusively during the course of another mental disorder, a separate diagnosis of Pica should be made only if the eating behavior is sufficiently severe to warrant independent clinical attention (Criterion D). Pica is frequently associated with Mental Retardation and Pervasive Developmental Disorders. Although vitamin or mineral deficiencies (e.g., zinc) have been reported in some instances, usually no specific biological abnormalities are found. In some cases, Pica comes to clinical attention only following general medical complications (e.g., lead poisoning as a result of ingesting paint or paint-soaked plaster, mechanical bowel problems, intestinal obstruction as a result of hair ball tumors, intestinal perforation, or infections such as toxoplasmosis and toxocariasis as a result of ingesting feces or dirt). Poverty, neglect, lack of parental supervision, and developmental delay increase the risk for the condition….”
As always if you have any comments or questions, please feel free to leave them and I will respond as soon as possible. Thank you!