Effectiveness of Homoeopathic Medicines in 50 Millesimal scale in the treatment of Pica in paediatric age group

December 15, 2024 admin Research in Homoeopathy 0

Dr Nahida M Mulla MD. (HOM), MACH

ABSTRACT:
 “Pica is defined as the persistent eating of non-nutritive, non-food items over a period of at least one month.” Pica is considered to be non – pathological up to 2 years of age, because they are in habit of exploring things while mouthing and teething. It is not a disease or disorder but behaviour that results from the interaction of biological, environmental and psychological factors. Pica is “Developmentally inappropriate” in children older than 18 – 24 months. Is an abnormal craving for non-nutritive items like clay, paper, chalk , crayons, baby powder, sand, soap, or food ingredients like raw potato and flour and also non-food items like earth, charcoal, raw rice, ice etc.

In Homoeopathic system of Medicine we treat the person as a whole and not the disease; we treat the patient individually with well indicated constitutional medicine.5The medicines are selected on the basis of totality of symptoms.

This is a sincere effort to identify and treat the cases of Pica as most of the condition remains un-noticed. This study is undertaken to ascertain the effectiveness of Homoeopathic Medicines in 50 millesimal scale in the treatment of Pica in paediatric age group.

AIM OF STUDY :
To assess  the effectiveness of  Homoeopathic Medicine in 50 millesimal scale     in the treatment of pica among paediatric age group.

The objectives of this study is:
To assess the effectiveness of individualised Homoeopathic Medicines in 50 millesimal scale  in the  treatment of Pica in paediatric age group.

The following methodology is adopted:

  • Study design: Prospective interventional study
  • Type of research: clinical study.
  • Sampling technique: Purposive sampling technique
  • Selection criteria: Subjects were selected based on inclusion & exclusion criteria.

CONCLUSION:
Homoeopathic medicines in 50 millesimal potency were found to be effective and safe in treating Pica in the pediatric age group. These findings support the use of individualized Homoeopathic treatment as a viable option for managing Pica in children.

KEYWORDS: Pica, Homoeopathy, 50 Millesimal scale, paediatric

INTRODUCTION:
Pica involves the persistent eating of non nutritive, non food substances (e.g., paper, soap, plaster, charcoal, clay, wool, ashes, paint, earth) over a period of at least 1 month. The eating behaviour is inappropriate to the developmental level (e.g. the normal mouthing and tasting of objects in infants and toddlers), and therefore a minimum age of 2 yr is suggested. The eating behaviour is not part of a culturally supported or socially normative practice. A diagnosis of pica may be assigned in the presence of any other feeding and eating disorder. Children with pica are at increased risk for lead poisoning, iron-deficiency anemia, mechanical bowel problems, intestinal obstruction, intestinal perforations, dental injury, and parasitic infections. Pica can be fatal based on substances ingested.

DEFINITION:
Pica is the compulsive eating of material that may or may not be foodstuff. The material is often consumed in large quantities without regard for nutritional consequences. The medical term comes from the Latin for magpie (Pica), a bird that by folklore incessantly gathers objects to satiate its curiosity. Many terms have been coined to describe certain picas. These terms have in common a Greek root for the material ingested followed by phagia, for “eating.”

PREVALENCE RATE:
Recent prevalence of Pica is not known as no studies are available. However World prevalence of pica from all the parts of the world varies from 10 to 32.5% of all the children surveyed of which 73% is seen among school going children.3 Pica is common during 2nd and 3rd  years of life where 25 to 33% of children it is seen.4

ETIOLOGY:
Numerous etiologies have been proposed but not proved, ranging from psychosocial causes to physical ones. They include nutritional deficiencies (e.g.iron, zinc, calcium), low socioeconomic factors (e.g., lead paint exposure), child abuse and neglect, family disorganization (e.g., poor supervision), mental disorder, learned behaviour, underlying (but undetermined) biochemical disorder, and cultural and familial factors. The differential diagnosis includes anorexia nervosa, factitious disorder, and non suicidal self-injury in personality disorders. A separate diagnosis of pica should be made only if the eating behaviour is sufficiently severe enough to warrant additional clinical attention.

CLINICAL PRESENTATION:
 The pica is usually a manifestation of an underlying medical condition, most often iron deficiency anemia. Yet compulsive eating, especially of inedible objects, can be a source of considerable embarrassment or ridicule. Hence, only a few patients come to the physician complaining of their unusual eating habit.

Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in non food items that are ingested. The symptoms may include:

  • Nausea
  • Pain or abdominal cramping in the stomach
  • Constipation
  • Diarrhoea
  • Fatigue
  • Behaviour problems
  • School problems

RISK FACTORS:

While the causes of Pica remain unknown, some of the risk factors for developing the disorder include the following:

  • Cultural factors.
  • Learned behaviour.
  • Low socioeconomic status.
  • Underlying mental health disorder.
  • Nutritional deficiency.
  • Child neglect.

DIAGNOSIS:
No single test confirms pica, but because pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition), the health care provider should test blood levels of iron and zinc. Hemoglobin can also be checked to test for anaemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The healthcare provider should test for infection if the patient has been eating contaminated soil or animal waste.

The DSM-5 posits four criteria that must be met for a person to be diagnosed with pica:

  1. Person must have been eating non-nutritive non foods for at least one month.
  2. This eating must be considered abnormal for the person’s stage of development
  3. Eating these substances cannot be associated with a cultural practice that is considered normal in the social context of the individual
  4. For people who currently have a medical condition (e.g pregnancy) or a mental disorder (e.g. autism spectrum disorder), the action of eating non-nutritive non foods should only be considered pica if it is dangerous and requires extra medical investigation or treatment on top of what they are already receiving for their pre-existing condition

MATERIALS AND METHODS:

SOURCE OF DATA
The subjects for the study were selected from the OPD,IPD and Health camps  at schools conducted  by A M Shaikh Homoeopathic Medical College and Hospital Belgaum

METHOD OF COLLECTION OF DATA

  • Study design: Prospective interventional study
  • Type of research: Clinical study.
  • Sampling technique: Purposive sampling technique
  • Selection criteria: Subjects were selected based on inclusion & exclusion criteria.

Cochran’s formula is used for calculating the sample size

Sample size:  n

N=  (1.65)2 x32.5×67.5 =60

100                                 n= sample size

z= statistical constant 1.65

p= prevalence rate

q= 100-p

d= significant error (10%)

Duration of the study: 24 months

Follow up: Follow up of the cases was done once in 15 days for first 3 months, later once in a month for next 3 months up to 9 months.

Inclusion criteria:

  1. 1. Subjects of paediatric age group of 2-14 years.
  2. Subjects diagnosed on the basis of ICD criteria
  3. Subjects who are willing to participate with written informed consent from parents and assent taken from the subjects.

Exclusion criteria:

  1. Subjects with mental retardation, autism spectrum disorder, or certain physical disorders.
  2. Subjects with other congenital or organic disease, intestinal obstruction due to parasites
  3. Subjects who are on other Medical line of treatment
  4. Subjects in whom eating behaviour is related to cultural practice in certain communities.

Result criteria:

RECOVERED
Disappearance of the clinical features of pica with no recurrence of the same within study period along with general well being of the subjects.

IMPROVED
Disappearance of the clinical features of Pica with recurrence of the same with lesser intensity, along with general wellbeing of patient, within the study period.

NOT RECOVERED
No relief of the symptoms even after sufficient time of treatment and till the end of study period.

RESULTS
The study was conducted between October 2022 to August 2024 and all the cases were sufficiently given time period to understand and analyse the outcome. At the end of the study following data is observed which is placed in tabular form.

1) Age Incidence: Statistical study was done to identify the age group with highest incidence as shown in Table No.1.

Table No. 1 – Age Incidence

Sl.No. Age in years No.of Subjects Percentage
1. 2-5 years 15 25 %
2. 6-9 years 25 42 %
3. 10 to 14 20 33%
Total 60 100%

As shown in table, maximum incidence of  Pica was seen in children aged 6-9 years, which may reflect a combination of developmental, behavioral, and environmental factors.

2)  Sex Incidence: Statistical study was done to identify the sex incidence with highest incidence as shown in Table No.2

Table No. 2 –Sex Incidence

Sl.No. Sex of subjects No. of Subjects Percentage
1. Male 35 58%
2. Female 25 42%
Total 60 100 %

Males exhibited a slightly higher incidence of Pica compared to females, but the difference was not substantial enough to suggest a strong gender predisposition.

3)Incidence of Presenting Complaints: In the statistical study of 60 cases, each subject is presenting with one or more complaints, the presenting complaints are shown in table no.-3.

Table No. 3 – Incidence of Presenting Complaints

Sl.No. Symptoms No. of Subjects Percentage
1. Ingestion of dirt or soil, clay, mud, 25 42%
2. Ingestion of paint chips 5 8%
3. Ingestion of ice 3 6%
4. Ingestion of chalk, paper 5 8%
5. Nausea, vomiting, 3 5%
6. Abdominal pain. 4 7%
7. Constipation, diarrhea, 5 8%
8. Fatigue, weakness, pallor, delayed growth. 5 8%
9. Hyperactivity, irritability, attention deficits, social withdrawal. 5 8%

 Table 4: Remedies prescribed:

S.no Remedies No. of Patients
1. Alumina 12
2. Calcarea carb 11
3. Cina 8
3. Ferrum met 7
4. Nitric acid 7
5. Silicea 7
6. Tarentula Hisp 2
7. Psorinum 2
8. Ignatia 2
9. Bryonia 1
10. Chamomilla 1
Total 60

 5) POTENCY USED: the following potencies are used in the study

Sl.no Potency No. of patients
1.        0/1    (LM) 32
2.        0/2 (LM) 28
   Total 60

6) RESULTS:

Result of Treatment: In the statistical study of 60 cases the results of the

Treatment are summarized in Table No.6

Sl.No. Results No. of Subjects Percentage
1. Recovered 30 50%
2. Improved 25 42%
3. Not recovered 5 8%
Total 60 100%

DISCUSSION

1) Maximum incidence of  Pica was seen in children aged 6-9 years, which may reflect a combination of developmental, behavioral, and environmental factors.

2) Males exhibited a slightly higher incidence of Pica compared to females, but the difference was not substantial enough to suggest a strong gender predisposition.

3) The subjects presented with the complaints of Ingestion of dirt or soil, clay, mud, paint

chips, chalk, paper & ice. They had sensation of nausea & vomiting; abdominal pain, constipation / diarrhoea; Fatigue, weakness, pallor, delayed growth. Few subjects presented with hyperactivity, irritability, attention deficits, social withdrawal.

4) The most effective remedies prescribed were Alumina, Calcarea carb, Cina, Ferrum Met, Nitric acid & Silicea.

5) Medicines were prescribed in LM potency. 32 patients received 0/1 & 28 patients 0/2 potency.

6) out of 60 patients 30 (50%)  patients recovered; 25 ( 42%) patients improved & 5 (8%) did not recover.

CONCLUSION
This study which was conducted on 60 subjects of paediatric age group concentrated mainly on utilization of 50 millesimal scale remedies.

The above study revealed the significant effect of individualized homoeopathic medicines in treatment and management of pica. The rapid and accurate detection, early treatment and management with specific homoeopathic therapy, management of co-morbid conditions, and efforts at primary prevention helps to overcome the acuteness and severity of pica in children.

Hence, it may be concluded that 50 millesimal drugs are well efficient in the treatment of pica.

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Dr. Nahida M. Mulla MD. (HOM), MACH
Professor , Hod  Pg Guide
Department of Paediatrics, A M Shaikh Homoeopathic Medical College, Belgaum -590010
E mail:drnahida.mulla@gmail.com
Mobile: 9448814660

 

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