"Why Is My Child Eating Dirt!"

The picture below is of a bird called Magpie found in Europe and Asia. It belongs to the crow family and is widely known for its intelligence as it is one of the few non-mammalian species to be able to identify itself in a mirror.

It is also known for another thing- it eats a lot of dirt and other non-food items.

Wonder why am I talking about a bird in this blog when I was supposed to talk about children who eat dirt?

To connect the dots- the Latin word for Magpie is PICA which is also the name of the eating disorder in children where the child eats dirt (the name of course inspired by the bird Magpie).

PICA is an eating disorder found in children greater than 18 months age, where the child eats chalk, dirt, plaster, paint and other non-food items repeatedly for more than a month.

A common complain of parents of kids of the age group 3-6 years is that the kid is eating dirt, chalk, window paint, cigarette butts, etc.

I have suffered from this myself as a kid and I remember licking walls and eating paint of window railings. I used to be scolded a lot by my parents but I liked it so much that I continued to do it when they were not around.

This disorder in medical terms is known as Pica.

To be diagnosed as pica the child has to be a minimum of 18 months of age and the habit has to be present continuously for at least 1 month.

When to see a doctor?

Studies show that 10–30% of children under the age of 6 engage in pica at some point.

Pica is diagnosed only when the habit is inappropriate for the child's age.

All infants put things into their mouth starting at around 6 months, and this is quite normal for their age.

The American Psychiatry Association published the DSM-5 criteria in 2013 for the diagnosis of Pica.

It is suspected when the following points are met:

(a) non-food items are consumed repeatedly for at least a 1 month

(b) the behavior is inappropriate for the individual’s developmental age (any such behaviour beyond the 18-month level is inappropriate)

(c) it is not a cultural practice of the community the child lives in (as there are communities in Africa and Asia where people eat non-food items as a ritual); and

(d)if the behavior is a symptom of another mental disorder and is severe enough to warrant medical attention

What causes Pica?

There is a common misconception that pica is caused by worm infestation which is not true. On the contrary, pica may lead to worm infestations as the child may pick up eggs of worms from the dirty things he/she is ingesting.

Many theories have emerged as to what causes pica but most of them could not be validated.

They include nutritional deficiency, family problems, stress, mental disorders, lack of human interaction, etc.

Many kids say that they engage in pica simply because they like the smell or taste of the items they ingest.

Health risks associated with Pica.

• Pica is associated with worm infestations (and not vice-versa as is commonly believed).

• Studies have found links between children eating ice and iron deficiency anemia.

• Ingestion of paints may lead to lead toxicity.

• Sharp objects may injure the teeth and gums. They may also obstruct or perforate the intestines.

How to treat Pica?

When you visit a doctor for pica, the first thing he will do is to deworm the child and give him iron syrup/tablets if there is anemia present.

He will also rule out autism by asking specific questions as pica is very common in autistic children.

Behavioral treatments have been tried with variable success. They include rewards for abstaining and punishments for engaging in pica.

Doctors have also tried replacing the non-food item with another edible item that is similar in texture or smell (eg chewable toys big enough to not be ingested).

Many times the child simply outgrows the habit as he/she grows.

Final words

In the end, I would like to say that pica is quite a common yet overlooked disorder in children.

If the child is between 2-6 years of age and has had the problem for more than a month then you should definitely visit a doctor.

Iron supplements and deworming are necessary.

Definitive cure is not available yet so the doctor may try one of the above harmless experimental strategies which you should comply with.

If you have any queries or confusions regarding pica, please feel free to comment below.

Regards,

Dr. Zeeshan

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