Pica (In pediatrics)

Pica is explained in very simple wording and style by the help of a scenario. Easy to remember and present due to interesting pictures. Helpful for medical students, parents having child with pica and knowledge seekers.

1. Pica Dr. Maria Sheraz Khan

2. CASE SCENARIO A 5 years old girl presented with H/O abdominal pain and distension examination shows long pink and round worms in stool. Blood count shows eosinophilia. Her mother told she has a habit of eating soil. What is your diagnosis? How will treat the patient?

3. KEY POINTS A 5 years old girl presented with H/O abdominal pain and distension examination of stool shows long pink and round worms. Blood count shows eosinophilia . Her mother told she has a habit of eating soil. What is your diagnosis? How will treat the patient?

4. DIAGNOSIS : Ascaris Lumbricoides infestation due to pica. TREATMENT : Mebendazole (100mg twice daily foe 3 days) OR Pyrantel pamoate (10mg/kg as a single dose) OR Albendazole (200-400mg as a single dose) OR Piperazine. Counseling.

5. Pica

6. pica Pica involves the persistent eating of non nutritive substances (e.g., plaster, charcoal, clay, wool, ashes, paint, earth) for a period of at least 1 month at an age in which this behavior is developmentally inappropriate (e.g. >18-24 months). The eating behavior is inappropriate to the developmental level (e.g. the normal mouthing and tasting of objects in infants and toddlers) and not part of culturally sanctioned practice.

7. Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning or hyperkalemia following ingestion of burnt match heads. In, particular geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections, such as toxoplasmosis and toxocariasis.

8. Although firm empirical data supporting any of the nutritional deficiency etiology hypothesis are absent, deficiencies in iron, calcium, zinc, and other nutrients (e.g. thiamine, niacin, vitamin C and D) have been associated with pica. Maternal deprivation, paternal separation, paternal neglect, child abuse, and insufficient amounts of parent/ child interactions have been associated with pica.

9. The ingestion of paint is most common in children from low socio-economic families and is associated with lack of parental supervision. Pica may be a serious behavioral problem because it can result in significant medical complication. Malnutrition and hunger may also result in pica.

10. epidemiology Pica appears to be more common in children with mental retardation. Pervasive developmental disorders, (e.g., Kleine-Levin syndrome, schizophrenia). Geophagia (eating earth) is associated with pregnancy and not seen as abnormal in some cultures (e.g., rural or preindustrial societies in parts of India and Africa)

11. Children with pica are at increased risk for lead poisoning, iron deficiency anemia, obstruction, dental injury, and parasitic infections. It usually remits in childhood but can continuo into adolescence and adult hood.

12. etiology Numerous etiologies have been proposed but not proved, ranging from psychosocial causes to physical ones. They include nutritional deficiencies (e.g., iron, zinc, and calcium), low socioeconomic factors (e.g., lead paint), child abuse and neglect, family disorganization (e.g., poor supervision), psychopathy, learned behavior, underlying (but undetermined) biochemical disorder, and cultural and familial factors.

13. Clinical features The physical findings associated with pica are extremely variable and are related directly to the materials ingested and subsequent medical consequences. Infections and parasitic infections: toxocariasis and ascariasis are the most common soil born parasitic infections associated with pica.

14. Toxic Ingestions: Lead toxicity is common. Physical manifestations of lead poisoning can include neurologic (e.g., irritability, lethargy, ataxia, in-coordination, headache, cranial nerve paralysis, papilledema, encephalopathy, seizures, comma and death.) and GIT (e.g., constipation, abdominal pain, colic, vomiting, anorexia and diarrhea) symptoms.

15. GIT symptoms may be evident secondary to mechanical bowel problems, constipation, ulcerations, perforations and intestinal obstructions caused by bezoar formation and the ingestion of indigestible materials into the intestinal tract.

16. treatment A combined medical and psychological approach is generally indicated for pica. The complication related to ingested item can require specific treatment (e.g., lead toxicity, iron deficiency anemia, parasitic infestation). Ingestion of hair can require medical or surgical intervention for a gastric bezoar.

17. Removal of toxic substances from the environment, particularly the lead based paints, is important. Nutritional education, cultural factors, psychological assessment, and behavior are important in developing an intervention strategy for this disorder.

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