Dad was pleased that his 3-year-old was healthy and developmentally ready to attend preschool. The boy was happy because he wasn't due for any vaccinations. As the office visit wrapped up, I wrote out an order for a screening blood test since the child lived in an area considered at higher risk for lead exposure.
The father hesitated a moment, then cautiously interrupted, "Doctor, sometimes my son eats paper, but so did I when I was young." This comment immediately raised a red flag, since pediatricians are trained to suspect iron deficiency anemia in children who tend to dine on nonfood items.
I added iron studies and a few other labs to the boy's order and, thankfully, all results came back in the normal range, and it appeared the child's extracurricular eating habit was just that -- a habit.
Pica, or the ingestion of nonfood objects, can occur in kids as habit behavior, as well as in children with developmental delay or those with some type of nutritional deficiency. The word pica derives from the Latin term for the magpie, a bird known to have a wide- ranging and indiscriminate appetite.
In an article in the Internet Journal of Head and Neck Surgery, Dr. J. S. Gulia and colleagues explain that pica is diagnosed when an individual repeatedly eats or mouths "non-nutritive" substances over at least a one-month period.
The group notes that it's considered normal for infants and toddlers to put just about anything they encounter into their mouths. So, it's not surprising that an estimated 75 percent of infants and 15 percent of 2- to 3-year-olds engage in pica.
After age 2 or 3, the practice is not considered typical and is classified as an eating disorder.
The exact cause of pica is unclear, but the behavior appears to have a higher incidence in iron and zinc-deficient patients, children with delays, kids seeking oral stimulation and for unknown reasons, in individuals with a family history of pica.
Dr. Gulia's team categorizes pica behaviors based on the nonfood items sought out by the affected child: amylophagia (laundry starch and cornstarch), geophagia (clay, sand and dirt), lithophagia (stones, gravel and pebbles), pagophagia (ice), trichophagia (hair) and -- collective shudder -- coprophagia (feces).
While many episodes of childhood pica resolve on their own, or after treatment of an uncovered nutritional deficiency, the eating disorder is not entirely benign.
Complications of pica can include lead poisoning, from the ingestion of lead-tainted soil or paint chips, and parasitic infections, following consumption of animal feces or contaminated soil and clay. The surgical researchers also cite case reports of constipation, as well as intestinal obstruction, ulceration and even perforation following the ingestion of a variety of non-nutritive items.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.