Problem Behavior: The Misunderstandings Of Pica Related To Iron Deficiency An Child Development
Amber Perry
University Of Memphis-Lambuth

Introduction

Pica is a common psychological disorder which is characterized by a person eating a large amount of substance that is non-nutrient such as paper, stones, paint, metal, and even soil.  Pica is one of the disorders that affected 25%-30% of the children in the United States (Marchi, 2016). It is a common disorder that is characterized by children or pregnant mother eating nonfood things. Reports show that 67% of pregnant women tend to crave for much nonfood substance as they believe it will boost their appetite 2016). On the other hand, most of the children have the behavior of putting things that are not edible in their mouth. Such types of behaviors are referring to as pica. With the increased cases of pica disorder, the government has tried to educate society on the best ways of dealing with that disorder.  It is important to note that there are various signs and symptoms related to pica. However, the common one is associated with equally eating nonfoods substance. It is not a must for s person to slow such nonfood particles. Some only prefer chewing it they throw it away. However, it can result in various diseases since the nonfood substance might react with the body of the person, especially to young children. To understand pica, various researches have been conducted to establish its causes, symptoms, and impact to both the children and adults.

According to DSM 5, lack of proper mineral deficiency is associated with Pica. However, it tends to vary depending on the immune system of the person. Some people tend to develop the disorder while they are only a few weeks old and the disorder will affect them until they are fully grown. In some cases, the child might develop it but later get better while he/she grows up. However, most of the children who develop the disorder while they were young are usually affected until they are fully grown. Low hemoglobin is another factor that is associated with pica 2016). This refers to the lack of red blood cells in the body that is responsible for carrying oxygen around the body. For pregnant mothers who develop that type of disorder, they are likely to be diagnosed with anemia.  More recent studies have indicated that pica is rated to obsessive-compulsive spectrum. Some people argue that pica is a common disorder that does not require a lot of attention. Such people argue that it is normal for children to eat nonfood substance since that re prone to put things on their mouth. However, reports show that this behavior is not normal and should be reviewed.

Methods

The use of survey is one of the methods of collecting data regarding pica. Since the discovery affects almost 25% of the children around the country, proper research needs to be conducted about it (Parry-Jones, 2017). By using a survey, it will entail collecting data from a large sample of people. Also, to ensure that the collected data is analyses well, the use of quantitative design would be appropriate. This type of research design will include sampling data from other researches and comparing it with what other authors have written about that discover. It is noted that the use of quantitative designs enables the researchers to monitor and even evaluate the preceding of these surveys. The purpose of questionnaires is another method of collecting data. Since it will require getting information from the mothers, the use of interviews will provide detailed information about the behaviors if such mothers.

 

 

 

 

 

 

 

 

 

 

Table 1 Types of Common forms of Pica

Table 1 Types of Pica

Acuphagia (Sharp Objects)

Amylophagia (Starch)

Geophagia (dirt, soil, clay)

Pagophagia (ice)

 

 

TABLE 2

Reported consumption of pica substances in a cohort of pregnant adolescents (n = 158)¹

Substance	All adolescents	Pica-reporting adolescents
	% (n)	% (n)
Ice	37.3 (59)	81.9 (59)
Starches (flour, cornstarch)	7.6 (12)	16.7 (12)
Powders (dust, vacuum powder, baby powder)	3.8 (6)	8.3 (6)
Soap (soap, bar soap, laundry soap, powdered cleansers)	3.2 (5)	6.9 (5)
Paper (regular paper, toilet paper, tissues)	2.5 (4)	5.6 (4)
Plastic/foam (stuffing from pillow/sofas, sponges)	1.9 (3)	4.2 (3)
Baking soda/powder	1.3 (2)	2.8 (2)
Olfactory (pine-scented cleaning agents, gasoline)	1.9 (3)	4.1 (3)2
Dirt, chalk	1.3 (2)	2.8 (2)

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¹Adolescents could report ingesting >1 pica substance.

²This percentage includes 1 adolescent who only reported olfactory cravings and, therefore, was not included in the pica group.

Table 3  Eating habits Questionnaire

Direct Questions

1.       Have you at any point ingested a substance that is not appropriate for eating? 2.       If yes, at what age? 3.       How often? 4.       What was the reason? 5.       What was the item/substance? 6.       Did it happen while you were pregnant (prior or after)?

 

 

By definition, Pica is an unusual eating disorder that makes people develop a craving for both edible substances as well as those that are not designed for human consumption. For years the condition has been discussed in journals since it was first discovered after a woman was diagnosed with the condition (Tisman & Khan, 2010). Since then, a lot of pica patients have been reported having ingested ice cubes, clay, chalk, starch, paste, cigarette butts and laundry starch out of the box. The condition mostly affects people with developmental disorders and it has also been observed in people of all ages and ethnicity but is widely spread in lower socioeconomic classes. About 25 to 33 percent of Pica documented cases are on small children while about 20 percent of people diagnosed are pregnant women, some of whom also have iron deficiency anemia (Tisman & Khan, 2010). The high cases of Pica are mostly because doctors are yet to truly identify the cause and trigger that pushes patients to consume the non-food substances especially because they have no nutritional value.

Pica poses major health risks that require medical attention. These patients are prone to suffer from electrolyte and metabolic disorders, lead and mercury poisoning, parasitic infections, intestinal obstruction and various problems of the gastrointestinal tract. Although the exact cause of pica is unclear but is associated to iron deficiency anemia (Khoshnevisasl et al, 2017). Most doctors also believe that pica to be an effect of iron deficiency rather than its cause. However, most of primary care physicians are not familiar with the signs and symptoms of pica. While Pica and iron deficiency anemia are not as serious as the various disorders that children and pregnant women can suffer from, their side effects, especially in the long run raises enough cause for alarm (Khoshnevisasl et al, 2017). Although iron deficiency does not always lead to death, its impact has significance especially due to the millions of children that suffer from irreversible brain injury caused by improper nutritional practices.

            Iron deficiency is a multi-system disorder with major effects on the central nervous system. Studies conducted over the last two decades have clearly shown the effect of iron deficiency on mental health and often on motor functioning as well. The lack of enough iron, for example, leads to reduced activity of iron containing enzymes in the central nervous system and it results to deficits that appear, based on animal studies and examining young children, to be irreversible despite of iron therapy (Khoshnevisasl et al, 2017). It is thus possible that the main effect of preventable loss of IQ in children suppresses the more clinically understandable intellectual and motor deficits resulting from disorders such as phenylketonuria and congenital hypothyroidism. Due to the adverse effects that iron deficiency has on children, it is important that pediatricians and caregivers pay closer attention to what children consume and keep better records of their iron intake especially in the ages of between 18 and 24 months (Khoshnevisasl et al, 2017). Doing so will ensure that they have acceptable amounts of iron in their systems and that they are less likely to be diagnosed with Pica.

            The difficulty in managing Pica lies mostly in the lack of a better understanding of the disorder as well as how lack of adequate iron leads to the disorder. Arguments have been made regarding the correlation between iron deficiency and pica but none is yet to identify an agreeable explanation (Tisman & Khan, 2010). Pica remains an unexplainable and mysterious disorder especially because the unusual eating disorders it causes disappear once the patients with the disorder receive iron supplements. Researchers trying to understand the disorder have tied it to various factors such as age, religion, gender and culture, to name a few, as well as others that affect a person’s mental development such as stress (Tisman & Khan, 2010). Often times, the disorder is also considered to be a symptom of specific deficiencies rather than their cause as is the case with Pica that results in consumption of clay.

            The advancement in technology also plays a major role in helping to understand Pica and its cause and symptoms. A good example is the understanding that practitioners had in relation to patients that had developed the habit of consuming ice cubes (Tisman & Khan, 2010). This disorder was initially said to be caused by excessive ingestion of ice cubes from the ice tray and also ingestion of the ice scraps found on the wall of the freezer. With the introduction of ice cube makers and automatic defrosters, pagophagia has changed as people have more creative ways of getting ice for ingestion and/ or sucking of the ice cubes (Tisman & Khan, 2010). The ice cubes are often consumed in various beverages such as super-sized McDonald like cups also from frozen bottled water. Iron deficiency anemia has also been attributed to the chewing of rubber band while patients with sickle cell anemia have been known to consume foam rubber.

            Since glossal pain is one of the side effects of iron deficiency, it has been suggested that patients ingest ice with the hope of reducing the discomfort associated with the disorder especially because ice has analgesic properties. However, since rubber foam and rubber bands lack any analgesic properties, it disqualifies the idea behind why they are consumed by patients with the disorder (Pignatti & Zanella, 2016). It has also been suggested that consumption of the non-food substances was done to compensate for lack of zinc and iron, the idea did not hold any ground especially because most of the substances consumed do not have any nutritional value. While stress, obsessive compulsive disorder and psychological problems have been suggested as triggers for Pica, there is no direct correlation between stress and the items patients choose to consume (Pignatti & Zanella, 2016). Some patients have even attested to enjoying the crunch experienced when eating Argo starch from the box or clay cookies.

            Another challenge that makes it difficult to find a permanent solution for Pica disorder is that it affects patients left unsupervised and also because they are less likely to mention the symptoms to their caregivers. The symptoms therefore go unnoticed and since doctors are unaware, patients can go on with the behavior without being aware of the side effects (Beyan et al, 2009). The cases of Pica are thus difficult to manage and in cases where pregnant women are diagnosed, it puts them at a disadvantage especially because the disorder is easier to control in the early stages.

Results

Results showed that 1-10 pregnant women are likely to be diagnosed with pica. For children, almost 45% of the children develop the disorder while they are young but learn to live with that condition. However, it will require close monitoring of the parent to train the child on how to live with the condition. That is why parents are encouraged to seek medical help once they discover their child is suffering from that condition.

Discussion

Psychology currents estimate that 43% of the institutional population is diagnosed with pica (Parry-Jones, 2017). Majority of this number are pregnant women while the rest are children. The disorder is not very common among men.  This is based on how society perceives the male gender. Most of the people believe that such behaviors are for young children and they will try to discourage the men on those behaviors. Before the doctor makes a diagnosis of pica, there are various factors that the specialist will have to evaluate. First, it is the blood level of the patients. Also, in some cases, the previous history of the patients is reviewed. It is noted that the disorder is heredity although not applicable to every person (Parry-Jones, 2017). In that way, it will be important for the medical doctor to identify the cause and the effect of that disorder on the patient.

Given the risk of medical complication, one of the ways of treating pica is through close monitoring of the behavior of the patient. It might take a much more extended period since it relates to the behavior of that individual. Additionally, collaborating with another mental health team in treating the disorder is also applicable.

 

 

 

Appendix A                Title		Author and Year Published	Journal	Participants	Setting	Intervention		Results	Generalization
Pica: A frequent symptom in iron deficiency anemia   Pica as a manifestation of iron deficiency Expert Review of Hematology   Pica in iron deficiency: a case series   The relationship between Pica and iron deficiency in Zanjan, Islamic republic of Iran: A case control study	Yan , Beyan, Ifran, and Kaptan, (2009)           Borgna-Pignatti, Caterina & Zanella, Sara. (2016)         Khan, & Tisman. (2010)         Khoshnevisasl, Sadeghzadeh, and Sadeghzadeh, (2017)		American Journal of Medicine                       Journal of medical case reports   World Health Organization	n/a               Children and pregnant mothers.                 Pregnant mothers and children           Pregnant mothers and children	Secondary source                 Secondary data source                 Secondary data source             Secondary data source		Co-relation between anemia and iron deficiency anemia     Co-relation between anemia and iron deficiency anemia                   Co-relation between anemia and iron deficiency anemia         Co-relation between anemia and iron deficiency anemia	Yes                 Yes                   Yes               Yes	Yes                 No                              Yes                        Yes

 

 

 

References

Borgna-Pignatti, Caterina & Zanella, Sara. (2016). Pica as a manifestation of iron deficiency.             Expert Review of Hematology. 9. 10.1080/17474086.2016.1245136.

Khan, Y., & Tisman, G. (2010). Pica in iron deficiency: a case series. Journal of medical case             reports, 4, 86. doi:10.1186/1752-1947-4-86

Khoshnevisasl P, Sadeghzadeh M, and Sadeghzadeh S, (2017) “The relationship between Pica     and iron deficiency in Zanjan, Islamic republic of Iran: A case control study” World    Health Organization

Marchi, M., & Cohen, P. (2016). Early childhood eating behaviors and adolescent eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 29(1), 112-117.

Parry-Jones, B., & Parry-Jones, W. L. (2017). Pica: symptom or eating disorder? A historical assessment. The British Journal of Psychiatry, 160(3), 341-354.

yan C, Beyan E, Ifran A, and Kaptan K, (2009) “Pica: A frequent symptom in iron deficiency             anemia” American Journal of Medicine