Pica: Does Your Child Eat Non-Food Items?

Understanding Pica in Children: What’s Really Going On?

Pica, the drive to eat non-food items like dirt, chalk, or paper, can be bewildering for parents. For children on the autism spectrum or with conditions like PANDAS or PANS, it’s particularly troubling. Officially recognised as an eating disorder in the DSM-5 since 2013, pica often signals more than a quirky habit. It may reveal unmet nutritional needs, sensory struggles, or genetic factors. Let’s take a look at what might lie behind this behaviour and practical ways to help.

 

What Pica Might Be Telling Us

Pica isn’t simply an odd behaviour; it’s often a sign that the body has an unmet need. Many children on the autism spectrum experience sensory processing difficulties, which can make everyday sensations overwhelming. For some, chewing or tasting non-food items can provide a sense of relief, helping them feel grounded.

Pica can also be a coping mechanism for stress or anxiety. Some children use it as a self-soothing behaviour, similar to rocking or humming. In other cases, pica can be linked to nutrient absorption issues. Even with a well-rounded diet, children may have difficulty absorbing certain nutrients if gut health isn’t optimal. Research in BMC Gastroenterology has shown that gut imbalances, like dysbiosis, can hinder nutrient uptake, driving behaviours like pica​

 

Key Nutrients Behind Pica

Nutrient deficiencies are frequently at the root of pica. It’s not only about having these nutrients but also ensuring the body can absorb and use them effectively. Here’s a closer look at how certain deficiencies contribute to pica.

Iron: Vital for Energy and Brain Health

Iron is crucial for brain function and energy levels. Research, including a study from China on children with iron deficiency anaemia, found that children with both anaemia and pica displayed distinct behaviours compared to those without pica. These findings, published in BMC Hematology, confirm a strong link between low iron levels and pica, particularly in children on the autism spectrum. However, iron absorption often relies on adequate levels of copper​

Zinc: Essential for Sensory and Immune Health

Zinc is another key nutrient that can influence pica. Known for its role in immune health, zinc also supports sensory processing and cognitive development. Deficiency in zinc has been associated with heightened sensory cravings and the urge to consume non-food items. Studies suggest that children with zinc deficiencies may exhibit symptoms of irritability and difficulty concentrating, both of which can impact behaviours like pica.

Copper: Supporting Iron Absorption

Copper, often overlooked, is essential for metabolising iron. Copper works in tandem with iron to ensure it is properly distributed throughout the body. When copper levels are low, iron can accumulate in places where it isn’t needed, which limits its effectiveness. Balancing both iron and copper is often key to addressing pica.

Vitamin D and Selenium: Balancing Brain and Immune Health

Low levels of vitamin D have been linked to pica, particularly in adolescents. Vitamin D, which plays an important role in brain and immune health, can influence behaviour when deficient. Selenium is equally important, as it supports the body’s antioxidant defences and helps reduce oxidative stress. High oxidative stress, a condition in which free radicals overwhelm the body’s defences, has been linked to pica behaviours, suggesting that proper levels of vitamin D and selenium may help reduce these cravings.

The Role of Genetics in Pica

For some children, genetic factors contribute to pica. Variations in the methionine cycle, a pathway that affects how the body handles nutrients, can impact how certain nutrients are processed and transported. Choline, for instance, is critical for brain health, but children with specific genetic variations may have slower transport of this nutrient. Pyrroloquinoline quinone (PQQ), a cofactor found in soil and kiwi fruit, can support choline transport, and some children instinctively crave soil as a source of this nutrient.

Gut Health and Pica: The Missing Link

Gut health is essential for nutrient absorption, so even the best diet may fall short if gut health is compromised. Imbalances in gut bacteria, such as low levels of Lactobacillus or Bifidobacteria, can worsen nutrient deficiencies and encourage pica behaviours. Adding probiotic-rich foods, such as kefir, sauerkraut, and yogurt, can help restore gut balance and support nutrient uptake.

Recognising When Pica Becomes Dangerous

While pica can often be managed, it can turn dangerous if a child begins consuming hazardous items. Sadly, cases like that of James Frankish, a young autistic man who passed away after ingesting a plant material that led to a fatal blockage, highlight the risks involved. If your child’s pica involves sharp or toxic objects, seek medical advice without delay. Regular health checks and imaging, if necessary, can detect and prevent internal damage.

Practical Steps for Addressing Pica

If pica is affecting your child, consider these steps:

Consult a Healthcare Provider: Testing for deficiencies in iron, zinc, copper, vitamin D, and selenium can reveal underlying issues.

Introduce Nutrient-Dense Foods: Foods such as liver, slow-cooked meats, egg yolks, and bone broth are rich in key nutrients. Copper can be found in foods like macadamia nuts and sunflower seeds. Supplements may help but should be carefully balanced.

Support Gut Health: Probiotics like kefir or yogurt and reducing processed foods can improve nutrient absorption.

Work with an Occupational Therapist: A therapist can help your child find safer ways to meet sensory needs.

Case Study: Jacob’s Journey with Pica

Jacob, a six-year-old boy on the autism spectrum, had been chewing on paper and plastic for months. His parents were increasingly concerned, not only for his safety but also because the behaviour seemed to be intensifying. After visiting our clinic, we discovered that Jacob had low levels of iron, zinc, and vitamin D—all linked to pica.

Working together, we adjusted Jacob’s diet, introducing iron- and zinc-rich foods like beef, liver, and pumpkin seeds, along with targeted supplements. An occupational therapist helped Jacob find safer ways to meet his sensory needs. Within weeks, his pica behaviours began to decrease, his appetite expanded, and his energy levels improved. Today, Jacob is thriving, and his parents are relieved to see him engaging with food in a more balanced, positive way.

Conclusion: Addressing the Root of Pica

Pica isn’t simply an odd behaviour; it’s often a signal that something is missing, whether it’s a nutrient, sensory outlet, or gut health support. Understanding the signs, testing for deficiencies, and addressing both nutritional and sensory needs can help your child move past pica and achieve a better sense of overall well-being.

IMPORTANT

The information provided in this article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It is crucial to consult with medical doctors or qualified functional medicine practitioners to address specific health concerns and obtain personalised guidance tailored to individual needs. Never add any supplements to your plan until it has been assessed and approved by your medical doctor or a suitable qualified practitioner who is familiar with your health history. 

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References:

Gautam, C. S., & Saha, L. (2008). Iron deficiency in childhood and adolescence. BMC Hematology, 8(1), 1-10.

McDougle, C. J., et al. (1996). Pica in autistic disorder. The British Journal of Psychiatry, 168(2), 165-168.

Khan, S. A., et al. (2009). Iron-deficiency anemia and pica as presentation of emergency conditions in children. Canadian Journal of Emergency Medicine, 11(2), 184-186.