In addition, it may be viewed from a developmental perspective as a fixed circular reaction 22 or, more simply, reflective of something as straightforward as imitating the behavior of a family pet or a zoo or farm animal. Pica also may be experienced as an activity that modulates arousal (homeostatic) or, in an uncomplicated manner, a sensory activity that the child experiences as stimulating or pleasant (e.g., lead paint chips are sweet and chewy gasoline smells good). In this regard, children may learn to engage in pica because it provokes adult attention (positive reinforcement) or allows escape a nonpreferred activity (negative reinforcement). Hypotheses identical to those proposed to explain stereotypic self-injury are invoked to explain pica behavior. Like self-injurious behavior, pica in these populations is viewed as a subclass of stereotyped activity. The incidence of pica in children and adolescents with developmental disabilities, comparable with the distribution of self-injurious behavior, is most frequently observed in those with severe and profound mental retardation. 20a It is the most commonly observed eating disorder in these clinical populations. Pica is overrepresented among children and adolescents with autism spectrum disorders, mental retardation, and developmental disabilities, including some children and adolescents with epilepsy. BARRETT, in Developmental-Behavioral Pediatrics, 2008 NEUROPSYCHIATRIC THEORY The substance being ingested and the reason for ingestion should be determined, and the dangers explained in a way that is culturally appropriate. Health professionals counseling patients who practice pica should remain non-judgmental while strongly encouraging discontinuation of the practice. Pica has also been associated with reduced maternal serum ferritin and hemoglobin levels. Possible risks from the practice include hematological and gastrointestinal disorders and interference with nutrient ingestion and absorption. Some reasons given for pica behavior include the relief of nausea or nervous tension, having a pleasant sensation when chewing, an inherent craving for the substance, and encouragement by family members. Groups with a higher prevalence of pica (up to 20%) include those living in rural areas, persons with a childhood or family history of pica, and African Americans. Pica is characterized by the ingestion of non-nutritive materials such as dirt, clay, laundry starch, cornstarch, ice, chalk, burnt matches, baking soda, hair, stone, gravel, charcoal, cigarette ashes, mothballs, coffee grounds, and even tire inner tubes. TISDALE MPH, RD, in Handbook of Clinical Nutrition (Fourth Edition), 2006 Pica Gastrointestinal complications such as bezoars or obstructions may also suggest pica. Iron or zinc nutrient deficiencies may be suggestive likewise, lead or mercury poisoning may lead to the diagnosis of pica. Clinical suspicion is therefore required to diagnose pica in the ambulatory setting. Patients are likely to underreport pica behavior because of embarrassment or because they are not aware that such behavior might be worth reporting. In the absence of complications that might signal abnormal eating patterns, diagnosis depends on self-reporting. Many of these patients had low serum ferritin levels, suggesting a link between pica and iron deficiency.
Studies of pregnant, otherwise healthy women have found pica in approximately 8% of respondents. Estimates have varied widely within a particular population, depending on the criteria used. There have been few epidemiologic studies detailing the prevalence of pica. Researchers have described several theoretical approaches that attempt to explain the etiology from nutritional, sensory, physiologic, neuropsychiatric, cultural, or psychosocial perspectives. The cause of pica behavior has eluded researchers for centuries. Rose, Anne Victoria Neale, in Encyclopedia of Gastroenterology, 2004 Evaluation
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