What are options for treating PICA (eating crap)?

Pica is an eating disorder typically characterized by the continual eating of nonnutritive substances for a period of at least 4 weeks at an age in which this behavior is developmentally inappropriate (e.g., >18-24 mo). Today, the definition of PICA has been expanded to include eating of nonnutritive substances.

Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.

In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.

When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.

The variety of behavioral strategies that have been proven to be effective in treating PICA include

- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior