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Pica is an eating disorder characterized by the persistent ingestion of nonnutritive nonfood substances. Causes are multifactorial and include nutritional deficiencies, pregnancy, and developmental disorders. Diagnostic workup depends on the substance consumed but usually involves evaluation for anemia as an underlying cause and screening for associated complications (e.g., lead toxicity, GI complications, parasitic infections). Management involves addressing any underlying causes and/or nutritional deficiencies followed by behavioral interventions (e.g., positive reinforcement). Selective serotonin reuptake inhibitors (SSRIs) may be considered in patients with pica refractory to initial management.
The etiology is not entirely understood. Pica is associated with: 
- Examination is usually normal. 
- Complications of pica (e.g., dental damage, GI symptoms) may be present depending on the substance consumed. 
- Assess patients using the DSM-5 diagnostic criteria for pica.
- For patients who meet the criteria:
- For children with pica, consider assessment for .
|DSM-5 diagnostic criteria for pica |
|Additional features|| |
|All criteria must be fulfilled.|
Laboratory studies 
- , e.g.: 
- Pregnancy test for patients of childbearing age
- Consider the following based on the ingested substance:
- Suspected bezoar or obstruction 
- Suspected lead ingestion
- Management involves a multidisciplinary team (e.g., physicians, dietitians, social workers, dentists).
- Screen for red flags for eating disorders and, if present, admit for inpatient management.
- Address any underlying causes, e.g.:
- Treat associated complications of pica (e.g., , lead poisoning, bowel obstruction).
- Educate patients and caregivers on the condition and potential complications.
- Start behavioral interventions.
- For patients with refractory symptoms, SSRIs may be considered.
Behavioral interventions 
- Suggest substitutions (e.g., replacing sand and pebbles with Grape Nuts). 
- Educate caregivers to:
- Help children to distinguish between edible and nonedible substances.
- Use behavioral strategies (e.g. positive reinforcement, time-out).
- Referral for behavioral therapy or psychotherapy may be necessary, especially for patients with intellectual disabilities.
- Poor nutritional status 
Heavy metal poisoning 
- , e.g., from paint ingestion (most common)
- GI complications 
- Bacterial or parasitic infections from the ingestion of contaminated dirt or food, e.g.: 
- Dental complications: from mechanical damage to teeth 
- Electrolyte and/or acid-base abnormalities: for example, metabolic alkalosis from the ingestion of baking soda 
We list the most important complications. The selection is not exhaustive.