Pica in childhood

Specialty: Pediatrics.

• Ingestion of non-nutritive substances
• geophagy
• pagophagia

Why it occurs

• Iron deficiency anemia or severe zinc deficiency (dirt or ice pica is a well-described pathophysiological manifestation of iron deficiency, which is resolved by restoring the deposits)
• Neurodevelopmental disorders or Autism Spectrum Disorder (aberrant oral sensory exploration behavior or lack of discrimination of edible objects)
• Moderate to severe intellectual disability (difficulty understanding the danger or nature of non-food substances)
• Psychosocial factors and emotional deprivation (neglect, severe family stress or lack of environmental stimulation that leads the child to self-stimulating behaviors)
• Childhood psychiatric disorders (obsessive-compulsive disorder or severe eating disorders)

Initial workup

Analytical determination of lead levels in whole blood (leademia, priority if suspected ingestion of paint fragments or contaminated soil). Complete blood count, serum ferritin, serum iron and iron binding capacity (TIBC), as well as plasma zinc levels (rule out iron deficiency or zinc deficiency). Simple abdominal x-ray (useful to detect radiopaque bezoars, metallic foreign bodies, or dense masses of ingested earth or plaster). Serial coproparasitological examination (3 samples) to look for eggs or larvae of soil-transmitted parasites.

Standard management

• Ferrous sulfate or amino-chelated iron — specific treatment if anemia or iron deficiency is confirmed; dose of 3 to 6 mg/kg/day of elemental iron divided into 1 or 2 daily oral doses, preferably administered on an empty stomach or with acidic juices to improve absorption, maintaining treatment for 3 months after normalization of hemoglobin to replenish deposits
• Zinc gluconate — supplementation in case of demonstrated deficiency
• Lead chelators such as Succimer or Calcium disodium Edetate (calcium EDTA, indicated only by specialized clinical toxicology in cases of lead poisoning with lead levels greater than 45 mcg/dl).