Pica

Eating things that are not food. Common in learning disability and dementia, and it kills people.

What it is

Pica means persistently eating things that are not food: soil, paper, cloth, batteries, cigarette ends, faeces, stones.

It is common in people with a learning disability and in autism, and it occurs in dementia, in pregnancy and with iron deficiency anaemia.

It is a serious clinical risk and it is frequently managed as a behaviour rather than as a health issue. Bowel obstruction, perforation, poisoning, choking and infection are all real outcomes, and deaths from pica are documented in the LeDeR reviews.

Button batteries in particular cause catastrophic internal burns within hours.

Signs you might notice

Observed eating of non-food items, or evidence of it: missing objects, stained mouth, unexplained illness.

Abdominal pain, vomiting, constipation or bowel obstruction.

Dental damage.

Recurrent unexplained infections or anaemia.

Behaviour that increases when the person is bored, anxious, understimulated or in pain.

How it can affect day-to-day life

The default response is often restriction: removing everything from the environment. That is sometimes necessary and it is never sufficient, because it addresses access rather than cause.

The causes worth investigating are: iron or zinc deficiency, hunger, pain, sensory need, anxiety, and boredom. Several are treatable.

Blanket restriction also has a cost. A living space stripped of every object is not a home, and the least restrictive principle in the Mental Capacity Act applies here as much as anywhere. See mental capacity.

Supporting someone well

Check for iron and zinc deficiency. This is the most commonly skipped step and it sometimes resolves the problem entirely.

Look for pain and for hunger. Pica frequently increases when somebody is in undiagnosed pain or is not getting enough to eat.

Offer a safe sensory alternative: chewable jewellery, crunchy foods, textures that meet the same need.

Risk-assess by item rather than removing everything. A battery, a coin and a piece of paper carry very different risks and warrant different responses.

Treat any suspected battery ingestion as an immediate emergency. Do not wait for symptoms.

Record properly. Fiducia Together keeps behaviour records with the clinical record, so a pattern of pica alongside falling haemoglobin is seen by one person rather than two.

Where to get help

Ask a GP for blood tests and a referral to a learning disability team or psychiatrist with pica experience.

Raise it at the annual learning disability health check.

Suspected ingestion of a battery, magnet, sharp object or poison is a 999 or immediate A and E matter.