Pica

What pica is

The name comes from the Latin word for magpie, a bird known for eating almost anything. Many babies and toddlers mouth and taste objects as part of normal development, so pica is not diagnosed under about age 2. According to DSM-5-TR, pica means:

• Eating non-nutritive, non-food substances persistently for at least 1 month
• Behavior that is inappropriate for the person's developmental stage
• Behavior that is not part of a culturally supported or socially normal practice
• If it occurs with another condition, such as autism or pregnancy, it is severe enough to need separate attention

Common types

Causes and risk factors

There is no single cause. Common contributors:

• Iron deficiency anemia: the strongest link, especially for ice chewing. Cravings often stop within days to weeks of starting iron, before blood counts fully recover.
• Zinc deficiency and other nutrient shortages.
• Pregnancy: pica, especially for ice, clay or starch, is reported by a significant minority of pregnant people in some populations.
• Developmental conditions: autism spectrum disorder and intellectual disability, where pica can be persistent and severe.
• Mental health: stress, anxiety, OCD, schizophrenia, and neglect or deprivation in children.
• Cultural practices: eating clay (kaolin) is traditional in some regions. This is not classed as a disorder, though it can still cause harm.
• Sensory seeking: some people like the texture or crunch, which helps with self-soothing.

Dangers of pica

The risks depend on what is eaten:

• Lead poisoning: from old paint chips, plaster and contaminated soil. Lead harms brain development in children even at low levels.
• Blockage of the gut: from hair, cloth, paper or other items, forming bezoars. Can need surgery.
• Perforation: sharp objects can tear the bowel.
• Infections and parasites: from soil contaminated with roundworms or toxocara.
• Nutritional problems: clay and starch can block absorption of iron and other nutrients, and fill people up without nourishment. Starch adds calories and can raise blood sugar in pregnancy.
• Dental damage: cracked teeth and worn enamel from ice, stones or hard objects.
• Poisoning: from soap, detergents or chemicals.

Diagnosis

A doctor will ask what is eaten, how much and how often, and look for underlying causes. Many people are embarrassed to mention pica, so doctors often ask directly. Tests may include:

• Complete blood count and ferritin (iron stores)
• Zinc level
• Blood lead level, especially in children
• Stool tests for parasites
• X-rays or other imaging if a blockage or swallowed object is suspected

Treatment

Treat any deficiency

Iron supplements, prescribed after testing, often reduce cravings quickly, especially for ice. Zinc is given if low. Do not start iron supplements on your own without testing, and keep them out of reach of children, because iron overdose is dangerous for young children.

Behavioral treatment

For children and people with developmental conditions, behavioral therapy is the most effective approach:

• Differential reinforcement: rewarding eating appropriate items and alternative behaviors
• Teaching discrimination between edible and non-edible items
• Offering safe substitutes with a similar texture or crunch, such as crunchy vegetables or sugar-free gum
• Environmental changes: removing or locking away the items being eaten, and supervising at high-risk times

For adults, cognitive behavioral therapy and treating related anxiety, OCD or other mental health conditions can help.

Safety at home

• Fix peeling paint and test older homes for lead.
• Keep batteries, magnets, detergent pods, coins and small objects out of reach.
• Ensure supervision for people at high risk of swallowing dangerous items.

Outlook

Pica linked to iron deficiency or pregnancy usually resolves once the deficiency is treated or after the baby is born. In young children it often fades with age. In people with autism or intellectual disability, it can be long-lasting but often improves significantly with structured behavioral programs.

Frequently asked questions

What causes pica?

Pica is often linked to iron or zinc deficiency, pregnancy, autism, intellectual disability, stress and some mental health conditions. In some people no clear cause is found. Testing for nutrient deficiencies is an important first step.

Is craving ice a sign of iron deficiency?

Often, yes. Compulsive ice chewing (pagophagia) is strongly linked to iron deficiency, even before anemia develops. It frequently stops within days to weeks of starting iron treatment. Ask your doctor for a blood count and ferritin test.

Is pica in pregnancy harmful?

It can be. Eating clay, soil or starch can lead to infections, lead exposure, poor iron absorption, constipation and excess calories. Tell your prenatal care provider about any non-food cravings so they can check for anemia and advise you safely.

At what age is pica a concern in children?

Mouthing objects is normal in babies and toddlers. Eating non-food items regularly after about age 2, or for more than a month, should be discussed with a pediatrician, who may check iron and lead levels.

How is pica treated?

Treatment depends on the cause. Correcting iron or zinc deficiency often helps quickly. Behavioral therapy, safe substitutes and removing access to harmful items are key for children and people with developmental conditions. Related mental health conditions are treated too.