Pica Information sheet
What What Whta are
What is Success Other
Pica?
causes does Pica the risks Strategies
storey Ideas strategies
Pica? look like? of Pica?
What is Pica?
The origin of the word ‘Pica’ pronounced ‘PIE-kuh’ comes from the Latin word for the bird known as
the magpie. As these birds are known for eating substances unfit for consumption as first described
by Ambrose Pare (1509-1590). Pica is commonly described as repeated consumption or craving of/
for inedible or non-food items that hold no nutritional value. Children may eat one specific non-
edible items or lots of different ones.
However, children approximately between the ages of 18-24 month may try to eat items that are
not considered edible or food. This is not necessarily a sign or considered as ‘Pica’ but exploration of
new objects.
Also taking into consideration cultural norms – in some culture’s consumption of various non-food
items, is seen as a social ‘norm’ e.g., some cultures promote eating clay as part of a medicinal
practice.
What causes Pica?
It’s quite unclear as to what causes Pica, there are many theories surrounding Pica which appear to
overlap. Yet, there are some conditions that can increase the chances of developing Pica. Ali (2001)
estimates between 4% and 25% of children who develop Pica have developmental difficulties. Along
with;
- Learning disabilities (not moving on from early years, still seeking the development of
mouthing items for comfort and satisfaction.)
- Autism (There are several reasons an individual with ASD might develop Pica for example
seeking sensory input, being unable to differentiate between what is edible and what is not,
deficiencies, self-soothing)
- A diet that is lacking in iron or zinc (in an attempt to correct the balance, a craving of
inedible items has been associated with Pica tendencies.)
- Sensory (some children can feel drawn to items with some sensory characteristics which are
pleasing/ satisfying for example certain smells, tastes and textures. Thus, a child associates
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this eating behaviour with satisfaction – Research highlighted children eating cigarette butts
are reinforcing the behaviour from the nicotine).
- Emotional regulation – anxiety can drive a child to seek objects to chew or suck in an
attempt to self sooth and create a sense of comfort enabling them to self-regulate to an
optimal zone of arousal
- You may want to contact your GP to complete some checks i.e mineral deficiencies. Along
with suggesting a referral to a specialist service.
What does Pica look like?
Pica behaviour will be present for a minimum of a month and is no longer appropriate of their
developmental stage for the child. Some examples of items;
- Soil, clay, glass, sand, chalk
- Plasters
- Clothing
- Stones
- Coins
- Ice
- Hair, fluff
- Paint chips, plaster, glue
- Buttons, paperclips
- Paper
- Baking soda
- Pencils, pencil shavings
- Coffee grounds
- Toothpaste, soap
- Faeces, drinking urine
What are the risks of pica?
Most objects can pass through a child’s body with no harm. On the other hand, Pica can be possibly
life threatening. Some risks include;
- Choking
- Poisoning
- Vomiting
- Constipation
- Blockages in the gut and intestines
- Infections
- While some evidently pose a risk to the health and safety of a child another implication
could be Social isolation due to behaviours related to Pica that peers may deem this as
strange and unusual.
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Some strategies to safely satisfy Pica.
- Pica Box – This can be a great way of offering a child alternative food that are edible but also
have similar textures in order to replace the non-food items. A valuable online resource can
be found where occupational therapist Rachel Peek gives advice about Pica boxes and their
use please see link below.
(https://www.togethertrust.org.uk/news/together-trust-occupational-therapist-steps-tackle-
eating-disorder-vulnerable-children)
Rachel Peek also gives strategies on how to use the box. For example, she but a picture of the child
with a brief explanation of the intended use of the box. She labelled the edible items with non-edible
names see pictures below for more detail (Searls 2020).
Success storey
Rachel Peek goes on to describe her success with the box and the positive feedback she has received
from teachers and teaches assistance. One storey in particular can be found on the web page
accessed from the URL link above, detailing a child who was offered a celery stick as she was eating a
twig, when she was finished with the celery, she tapped the box for more. Furthermore, the child
lost all interest in nonedible and would instead go directly for the box. She also utilised Velcro
stickers to allow the child to pic which food item they wanted.
Food replacement ideas –
Box similar to these could be used to store the items of food –
along with putting the child’s photo on the top and maybe
some Velcro stickers
Celery, twiglets and
vegetable sticks substituting
twigs.
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Crisps and spinach leaves substituting tree
leaves.
Crushed biscuits, grapes, nuts and
corn flakes substituting sand, dirt,
rocks and gravel.
Beef jerky substituting bark and twigs
Granola substituting gravel, dirt and rocks.
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Rice paper substituting paper.
‘Love hearts’ substituting chalk.
Edible cookie dough and soft
brownie substituting faeces. (ensure
these are given in moderation -
smaller sizes)
Apple juice substituting urine.
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Other strategies are chewable objects.
The chewable jewellery comes in all different shapes, sizes and colours. These
can be purchased from online stores – if you type into a search engine
‘chewable jewellery’. Or if you’re looking for a more specific chewable object
type in for example ‘Lego chewable jewellery’.
Other ideas - print out and laminate prompt cards as mentioned above, for
the child to give when wanting to engage in Pica behaviour for example,
leaves, bark, sand, rocks, gravel and twigs;
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Some other strategies
- Making the environment safe, ensuring that steps are taken to remove items that present a
risk from school/ home setting. This may look like carrying out a risk assessment of the
environment removing objects, setting boundaries and restricting areas.
- Positive reinforcement, implementing a reward system when an inedible object is resisted.
- Environment of a social nature, ensuring the child is participating socially and having a
sufficient level of interaction and ensure participation in physical activities and an optimal
level of sensory stimulation i.e using safe toys for sensory stimulation such as chewable
jewellery that cannot be swallowed.
- Discrimination techniques, teaching the child to be able to discriminate between objects
that are edible and those that are not. Encouragement of pausing to really think about what
they are putting in their mouth and help the child to consider if the item picked is to be
eaten or discarded.
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References;
Searls, A., 2020. Together Trust Occupational Therapist Steps Up To Tackle Eating Disorder
In Vulnerable Children | Together Trust. [online] Togethertrust.org.uk. Available at:
<https://www.togethertrust.org.uk/news/together-trust-occupational-therapist-steps-
tackle-eating-disorder-vulnerable-children> [Accessed 6 November 2020].
Mace, F. C., & Knight, D. 1986. Functional Analysis and Treatment of Severe Pica. Journal of
Applied Behavior Analysis. 19, 411-416.
Dudley, R., Ahlgrim-Delzell., L and Calhoun, M. (1999) Diverse diagnostic and behavioural
patterns amougst people with a dual diagnosis. Journal of Intellectual Disability Research,
43, 70-79.
Searls, A. 2020. Together Trust Occupational Therapist Steps Up To Tackle Eating Disorder In
Vulnerable Children | Together Trust [Online]. Available at:
https://www.togethertrust.org.uk/news/together-trust-occupational-therapist-steps-tackle-eating-
disorder-vulnerable-children [Accessed: 23 November 2020].
