PICA (Abnormal cravings) in children and homoeopathic management

Dr SB Janagoud

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.¹

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.²

OBJECTIVES

1. To understand Pica and its Presentations in Children’s.
2. To understand the Homoeopathic Management of Pica in Children with the help of Materia Medica

KEY WORDS : Pica, Children, Homoeopathy Medicines.

INTRODUCTION
The term Pica comes from the Latin for “Magpie” a bird for its indiscriminate and unusual eating habits.¹ 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 2^ndand 3^rd years of life where 25 to 33 % of children it is seen.⁴ 

Subtypes are characterized substance eaten:

• Amylophagia (starch)
• Coprophagia (faeces)
• Emetophagia (vomit)
• Geomelophagia (raw potatoes)
• Geophagia (dirt, soil, clay)
• Hyalophagia (glass)
• Lithophagia (stones)
• Mucophagia (mucus)
• Pagophagia (ice)
• Trichophagia (hair)
• Urophagia (urine)
• Xylophagia (wood)

This type of eating should last for one month to fit the diagnosis of Pica.²

ETIOLOGY:
The exact aetiology is not known for Pica. Some proposed hypothesis suggests that organic, psychodynamic, socioeconomic and cultural factors have been implicated. Research has reported high prevalence of Pica individuals documented iron deficiency. Traumatic events like parental separation, broken families, parental neglect, lack of parent child interaction and child abuse. Ingestion of paint is common for led poisoning in case of children’s belongs to low socioeconomic status and associated with lack of supervision. Sometime developmental disabilities have Pica due to their inability to discriminate food and non-food items. Even persons with Psychosis Sometimes eat non edible materials. Pica is a cultural feature of some religious rituals, folk medicine and magical beliefs.¹

CLINICAL FEATURES:⁵
Child with eating habits of substances like clay, dirt, stones, pebbles, pencil, eraser, lead, plastic, faeces, hair, paper, finger nail, paint, chips, chalk, wood, plaster, light bulbs, needles, string, cigarette ,wire and burnt matches.

A case with history of Pica may present with symptoms of constipation, chronic or acute, diffuse or focused abdominal pain, nausea, vomiting, loss of appetite.

On examination-abdominal distension, pallor, iron deficiency anaemia which could be the case of Pica.

Clinical presentation of Pica is highly variable and is associated with specific nature of resulting medical conditions and the indigested substances.

Parasitic infestations are usually associated with Pica. Ascariasis is commonly seen in children with Pica.

DIAGNOSTIC CRITERIA

DSM-V DIAGNOSTIC CRITERIA FOR EATING DISORDERS: PICA⁶

1. Persistent eating of non-nutritive, non-food substances over the period of at least one month.
2. The eating non-nutritive, non-food substances the inappropriate to the developmental level of the individual.
3. The eating behaviour is not a part of culturally supported or socially normative practice.
4. If the eating behaviour occurs in the context of another mental disorder (e.g; intellectual disability, autism spectrum disorder) or medical condition (e.g; pregnancy), it is sufficiently severe to warrant additional clinical attention.

RUBRICS OF PICA UNDER VARIOUS REPERTORIES

1. Repertory of Homoeopathic Materia Medica by J.T.Kent, AM, MD^7. Chapter-Stomach-desires-lime, slate pencils, earth, chalk, clay etc- NIT-AC, alum, calc, cicut, nat-m, nux-v.

Charcoal desire- alum, cicut, con, nit-ac, nux-v

2. A Concise Repertory of Homoeopathic Medicines by Dr.S.R.PATHAK⁸– Cravings-

Charcoal- alum, calc, cicut, psor

Lime, chalk, clay, earth- alum, ant-c, calc, cicut, ign, nit-ac, nux-v, psor, SIL, sulph, taren

3. Homoeopathic Medical Repertory by Robin Murphy, ND⁹ – chapter-Pica, desires to eat-sand, slate, earth etc- ALUM, alumn, CAL, cal-p, chel, cicut, con, ferr, hep, hyos, ign, nat-m, nit-ac, nux-v, oci, psor, sil, sulp, tarent
4. Synthesis treasure edition by Fredrick Schroyens- Generalities- food and drinks- charcoal desire- alum, calc, cic, con, ign, nit-ac, nux-v, psor

Generalities-food and drinks- lime, slate, pencils, earth, chalk, clay desire- alum, alumn, ant-c, calc, cal-p, chel, cic, ferr, ign, lac-f, nat-m, NIT-AC, nux-v, oci, petr-ra, psor, sil, sulph, tarent, tub.

5. Homoeopathic Repertory by William Boericke, MD¹⁰– Stomach-appetite-perverted cravings (PICA)- Charcoal, coal, chalk etc- alum, calc, cic, ign, nit-ac, psor.

HOMOEOPATHIC REMEDIES¹¹

Alumina

• Impressions reach the mind with a marked degree of slowness. Time passes too slowly.
• Delicate children having dark complexion who are given artificial baby foods or are bottle fed.
• Big bellied children.
• Constipation; has to strain even for soft stools.
• Craving for indigestible things like Chalk, Starch, Charcoal, dry rice, and other unnatural and indigestible substances. (Cicuta, Psorinum).
• Aversion and aggravation from eating potatoes.
• Dryness
• Dryness of skin and mucous membranes.

Calcarea carbonica

• Fat, Fair, Flabby (Emaciated does not rule out Calcarea carb).
• Large head and abdomen; fontanelles and sutures open; bones soft, develop slowly.
• Feels better when constipated.
• Craves icy cold things, ice-creams; indigestible things.
• Aggravation from milk.
• Easy sweating on slightest exertion. In the night they wet the pillows with sweat.
• Child who is timid, cautious and always sticking to mother.     

Ferr metallicum

• Very firm in their opinions. Once convinced about an idea, it is very difficult to change it and they always feel that they are right.
• Congestions with tendency to recurrent haemorrhages, especially of upper air passages (Ferrum-phos).
• Canine hunger alternating with complete loss of appetite.
• Craving for bread, raw tomatoes.
• Aversion meat, eggs; Intolerance of eggs.

Nitric acid

• Suited to lean children of rigid fibres.
• A broken down and greatly debilitated child who suffers from diarrhoea off and on all the time; sunken eyes and face with pale yellow complexion and deep lines of suffering character. 
• Irritable, vindictive.
• Craving for indigestible things, fat salt.
• Discharges are excoriating, thin, dirty or brown, offensive.
• Affinity for muco-cutaneous junctions ulcerations, fissures, warts, condylomata.
• Profuse sweat. Offensive sweat in armpit and feet.
• Better by riding in carriage. Headache, epilepsy, mental symptoms, etc…

Psorinum

• Pale, sickly, delicate children.
• Peevish, scrofulous, unhealthy-looking children who emit a disagreeable odour.
• Anticipation. Feels restless for days before a thunderstorm.
• Want of self confidence.
• Distension of abdomen in children.
• Sweats easily.
• Feels unusually well the day before an attack. Very hungry a day before an attack.

Silicea

• Suited to growing children who suffer from malnutrition due to imperfect assimilation.
• Body emaciated, abdomen distended, large-headed with open fontanels and sutures, weak ankles (slow learning to walk).
• Delicate features like a porcelain doll; light complexion, fine and dry skin.
• Profuse sour smelling sweat over scalp while the body is dry.
• Child is yielding, mild anxious and faint-hearted.
• Lacks physical stamina. Wants to lie down.
• Often develops a dislike of, or intolerance of milk, and the cervical glands may be enlarge.
• Children perspire all about the head; the head is wet from sweat, especially at night.
• Offensive foot sweat with rawness between toes.
• Stools are very dry, knotty, partially expelled recedes back, has to be removed mechanically.

Tarentula hispanica

• The typical picture of Tarentula is the “Popeye baby”. Popeye is a cartoon character who has tremendous strength despite being lean and thin.
• Emaciated, nervous, hysterical children.
• Tremendously hurried, intense, excited and restless. Everybody must hurry.
• Craves raw food. Eats indigestible things.
• Dancing on hearing music. 

REFERENCES:

1. Kaur J. Pica as a Culture Bound Syndrome. 2014 Apr. Available on: http://medind.nic.in/daa/t14/i1/daat14i1p144.pdf
2. Wadhawan R, Luthra K, Khurana PR, Solanki G. Pica disorders: Are dentists Aware. Int J Adv Dent Res. 2015;1:20-5.  Available on https://pdfs.semanticscholar.org/bea1/9d410330858532adb6fb5a5f5e0abe78935a.pdf:
3. Pasupathi S, Swarna S.Clinical profile, sociodemographic and biochemical determinants of PICA among 1 to 5 aged children attending a tertiary care hospital. International Journal of Contemporary Pediatrics; 2018 Nov; 5:2076-82. Available on: https://www.ijpediatrics.com/index.php/ijcp/article/viewFile/1880/1387
4. Murali C, Seshasai S. The study on pica at tertiary care hospital. IJAR. 2018;4(2): 227-9.  Available on: http://www.allresearchjournal.com/archives/2018/vol4issue2/PartD/4-2-48-927.pdf
5. Central Council for Research in Homoeopathy. Homoeopathy for Mother and Child Care (PEDIATRICS). In collaboration with in country office, WHO., INDIA, New Delhi, 2009;134-135
6. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders:DSM-V.Arlington VA,APA,5^th Ed,2013;329-354.
7. J.T.KENT, Repertory of the homoeopathic material medica, 6/e. New Delhi, B.Jain Publishers(P) LTD.485.
8. Dr.Pathak SR. A Concise Repertory of Homoeopathic Medicines, 4/e, New Delhi, B Jain publisher(P) LTD; 85-86
9. Robin Murphy, ND. Homoeopathic Medical Repertory 3/e.(revised) B.Jain publishers(p). Ltd. 2018;888.
10. William Boericke. Pocket manual of homoeopathic material medica and repertory. low priced edition New delhi; Jain Publishers(P) Ltd.2016.
11. Dr.Jain Pravin B. Essence of Pediatric material medica. 2/e Nitya Publications, Mumbai.2016

Dr.S.B.Janagoud
(Inservice) Medical Officer, Government of Karnataka
MD Part-1, Department of Paediatric
Government Homoeopathic Medical College, Bengaluru-79