Pica

Pica (also known as pica syndrome) is an eating disorder in which a child repeatedly puts things in their mouth and swallows them over an extended period of time—things that are not food and have no nutritional value. These include, for example, dirt, sand, chalk, paper, hair, soap, paint, or wall plaster. The name derives from the Latin word for the magpie (Pica pica), a bird that indiscriminately collects objects.

Pica is diagnosed when this behavior persists for at least one month and is no longer appropriate for the child’s developmental stage. In the International Classification of Diseases, pica is coded as F98.3; in the American manual DSM-5, it is listed under the name “pica.” Unlike an eating disorder such as anorexia, pica focuses on what a child eats rather than on quantity or body weight.

Many babies and toddlers put things in their mouths to explore their world. During the first one to two years of life, this is a normal part of development and no cause for concern. Experts only diagnose pica when a child is old enough to distinguish between edible and non-edible items but still regularly eats non-edible things.

Signs parents can look out for:

• The child repeatedly and deliberately eats certain non-edible substances, such as dirt, chalk, or paper.
• The behavior persists for weeks and is difficult to stop.
• Physical consequences occur, such as stomachaches, constipation, or abnormal blood test results.

A brief, one-time taste out of curiosity is different from a recurring pattern. Food refusal in early childhood and restricted eating behavior associated with ARFID are also distinct conditions that must be distinguished from pica.

Pica has several possible causes. It often occurs in children whose development follows a different course, such as children on the autism spectrum, those with intellectual disabilities, or those experiencing other psychological distress. For these children, chewing and swallowing certain materials can be appealing or soothing.

In rarer cases, a deficiency may be the underlying cause: for example, if the body lacks iron or zinc, a craving for unusual substances such as clay or sand may develop. For this reason, blood tests are always part of the diagnostic process.

It is difficult to say how common pica is. In a study conducted in Leipzig involving approximately 800 children between the ages of 7 and 14, just under five percent repeatedly ate items not intended for consumption. Such behavior is significantly more common among younger children and often resolves on its own as they get older.

The child’s safety comes first, because some substances that are swallowed can be dangerous. Paint may contain lead, swallowed objects can cause an intestinal obstruction, and soil can transmit parasites. For parents, this means in everyday life:

• Keep small parts and hazardous materials out of reach.
• Ensure a safe, well-supervised environment.
• Keep an eye on what young children put in their mouths.

If a nutrient deficiency is present, it is treated specifically, and the behavior often improves as a result. If a deficiency is not the cause, behavioral therapy has proven particularly effective, in which the child learns, step by step, to stop eating non-edible items. To date, there are few established, well-supported standard treatments for pica, so treatment is tailored individually to each child.

Parents should seek professional advice if their child repeatedly eats non-edible items, if physical symptoms arise, or if they are unsure whether the behavior is still part of normal development. The first point of contact is the pediatrician. They can determine whether there is a deficiency or a health risk and whether a referral is necessary.

In cases of persistent or severe pica, further evaluation takes place in a child and adolescent psychiatry clinic, often in collaboration with other specialists. This can provide relief for parents, as they do not have to bear the responsibility alone.

Rückenwind “Eltern” provides support in this process through coaching, but does not replace medical treatment. A diagnosis and the decision regarding therapy can only be made by a child and adolescent psychiatry clinic or by a medical or psychotherapeutic specialist.