Babies put things in their mouths. That is how they learn. After about two, persistent eating of things that are not food — dirt, paint, soap, paper, chalk, hair, ice in handfuls — is a different problem. The name is pica. It is a medical and safety issue before it is a behaviour plan.
We are a therapy centre. We do not diagnose pica, we do not run an emergency department, and we will not start a behaviour programme until a doctor has looked. If your child has swallowed something sharp, a battery, or a large amount of anything, that is 1122 or the nearest emergency department now — not WhatsApp.
How common is it?
A large US case-control study (Study to Explore Early Development) looked at children aged 30 to 68 months. Pica was reported in 3.5% of general-population children, 23.2% of children with autism, and 8.4% of children with other developmental disabilities. Inside the autism group it was 28.1% when intellectual disability was also present, and 14.0% when it was not. Children with a developmental disability but neither autism characteristics nor intellectual disability looked like the general population (3.2%).
Those numbers are from one study in one country, in preschoolers. They are not a diagnosis of your child. They are why we take this seriously instead of calling it a phase.
The doctor first — not optional
Ask the paediatrician, clearly, for:
- Iron studies (including ferritin) and a zinc level — a meta-analysis of 43 studies found pica associated with about 2.4 times the odds of anaemia and with lower plasma zinc; the authors could not say which comes first, and treating a deficiency does not always stop the behaviour
- Lead testing if they eat paint, dirt, or live in an old house with peeling paint
- Gut symptoms: constipation, pain, blood, vomiting, a swollen belly
Lead, blockage and poisoning are medical. Behaviour work on top of an untested child is the wrong order. DSM-5 does not diagnose pica under two, because mouthing is typical then. After that, a month of repeated non-food eating that is not part of a cultural practice is the threshold clinicians use.
What you can do at home while you wait for the appointment
- Lock paint, bleach, medicines, batteries and small objects. This is safety, not a personality project
- Watch, do not lecture. Note what, when, and what happened just before
- Offer a safe chew (a chewy tube or a firm snack) if the drive is sensory, once a doctor has said the mouth is not a medical emergency
- Do not use chilli, shouting or “teaching them a lesson”. Shame does not stop pica. It hides it
If the medical work-up is clear and the behaviour is still there, a behaviour plan can help: interrupt, redirect, teach a request, keep the dangerous items gone. That sits with our ABA team under Mahnoor’s plan — Noor Fatima and Atika Zainab deliver those hours. We still will not call it cured.
Related: autism support, intellectual disability, picky eating (a different problem), chewing clothes and pencils (usually sensory, not pica), wandering.
Sources
- Fields VL, Soke GN, Reynolds A, et al. Pica, autism, and other disabilities. Pediatrics. 2021;147(2):e20200462. PubMed 33408069
- Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status. American Journal of Human Biology. 2015;27(1):84–93. PubMed 25156147
A consultation about behaviour after the medical checks is Rs 1,500 for up to 50 minutes, Monday to Friday, 2pm to 6pm, in Model Town or online. Contact.