Last updated: March 15, 2023

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Pica is an eating disorder characterized by the persistent ingestion of nonnutritive nonfood substances. Causes are multifactorial and include nutritional deficiencies, pregnancy, and developmental disorders. Diagnostic workup depends on the substance consumed but usually involves evaluation for anemia as an underlying cause and screening for associated complications (e.g., lead toxicity, GI complications, parasitic infections). Management involves addressing any underlying causes and/or nutritional deficiencies followed by behavioral interventions (e.g., positive reinforcement). Selective serotonin reuptake inhibitors (SSRIs) may be considered in patients with pica refractory to initial management.

Epidemiological data refers to the US, unless otherwise specified.

The etiology is not entirely understood. Pica is associated with: [1][3]

  • Examination is usually normal. [3]
  • Complications of pica (e.g., dental damage, GI symptoms) may be present depending on the substance consumed. [3]

Approach [3]

Diagnostic criteria

DSM-5 diagnostic criteria for pica [3][5]
  • Persistent ingestion of nonnutritive nonfood substances (e.g., hair, clay, soil, ice, paint chips)
  • Present for > 1 month
Additional features
  • Inappropriate for developmental age
  • Not part of culturally or socially normative practice
  • If another medical or psychiatric condition is present, the pica behavior warrants specific clinical management.
All criteria must be fulfilled.

Laboratory studies [1][3]


Approach [1][3]

Behavioral interventions [1][3]

Pica in pregnancy and young children is typically self-limited. [3]

We list the most important complications. The selection is not exhaustive.

  1. Leung AKC, Hon KL. Pica: A Common Condition that is Commonly Missed - An Update Review. Curr Pediatr Rev. 2019; 15 (3): p.164-169. doi: 10.2174/1573396315666190313163530 . | Open in Read by QxMD
  2. McNaughten B, Bourke T, Thompson A. Fifteen-minute consultation: the child with pica. Arch Dis Child Educ Pract Ed. 2017; 102 (5): p.226-229. doi: 10.1136/archdischild-2016-312121 . | Open in Read by QxMD
  3. Weiss, R. Introduction to Abnormal Child and Adolescent Psychology. SAGE publications ; 2017
  4. Liu H, Burns RT, Spencer BR, Page GP, Mast AE. Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors. Transfusion. 2021; 61 (7): p.2090-2098. doi: 10.1111/trf.16409 . | Open in Read by QxMD
  5. Lumish RA, Young SL, Lee S, et al. Gestational Iron Deficiency Is Associated with Pica Behaviors in Adolescents. J Nutr. 2014; 144 (10): p.1533-1539. doi: 10.3945/jn.114.192070 . | Open in Read by QxMD
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association ; 2013
  7. Hauptman M, Bruccoleri R, Woolf AD. An Update on Childhood Lead Poisoning. Clin Pediatr Emerg Med. 2017; 18 (3): p.181-192. doi: 10.1016/j.cpem.2017.07.010 . | Open in Read by QxMD

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