PICA- Every intake is not food

Dr Riya Kumar

ABSTRACT
Pica is an eating disorder in which instead of nutritious food, the patient craves for the non-nutritive and non-digestible things. Normal in toddlers but may continue to occur in later age groups causing health issues from mild infections to major complications.  Fortunately, in many cases pica will remit with time, sometimes gets neglected from gaining the attention of attendants as well as of physician. By taking detailed history about the behavior and the particular thongs craved, one can help the patient with appropriate homoeopathic medicine selection and proper guidance and counseling to the parents. The disorder being a minor one, sometimes gets neglected from gaining the attention of attendants as well as of physician.

INTRODUCTION:-
PICA is an eating disorder, defined as a pattern of eating non-nutritive substances for atleast one month, inappropriate to the child’s developmental level and culturally sanctioned practice. The substances commonly ingested are clay or dirt (Geophagia), paints, pencil leads (Plumbophagia), ice (Pagophagia), starch (Amylophagia), faeces (Coprophagia), hair (trichophagia), plaster, ash, cloth, coal, soap etc.

INCIDENCE:-
Pica is a normal developmental behavior upto 2 years of age, as mouthing of all objects is normal in infants & toddlers. But, it may continue into adolescence and adulthood. Presence of Pica beyond this age is abnormal and needs investigation.

Incidence is relatively higher in low socio-economic status.

ETIOLOGY:-

Although, Pica is largely a behavioral disorder, it has been associated with-

1. Mental retardation
2. Emotional neglect
3. Iron and zinc deficiency
4. Worm infestations
5. Poor supervision
6. Family disorganization

CLINICAL MANIFESTATIONS:-

1. Intake of non—digestible substances
2. Stomach upset.
3. Stomach pain.
4. Blood in the stool (which may be a sign of an ulcer that developed from eating nonfood items).
5. Bowel problems (such as constipation or diarrhea).

DIAGNOSIS:-

1. Blood Examination- Hemogram for Anemia and infections
2. Stool Examination- for Worm Infestations
3. Serum Lead Estimation may be required in relevant cases

DIFFERENTIAL DIAGNOSIS:-

Differential diagnosis of pica includes more serious psychological disorders. Example-

1. Autism- A developmental disorder that impairs the ability to communicate and interact.
2. Schizophrenia- In this, the patient confuses the real world with the world of imaginations.
3. Klein-Levine Syndrome (KLS)- In this syndrome, the patient suffers from recurring periods of an excessive amount of sleep, altered behavior, and reduced understanding of the world.

COMPLICATIONS:-

Children with Pica are at risk for:-

1. Certain infections
2. GIT Problems- Eg. Recurrent abdominal pain, diarrhea or worm infestations
3. Chronic lead poisoning, and
4. Iron deficiency anemia
   Rarely, these cases may develop
5. Bezoars
6. Intestinal obstruction or perforation

MANAGEMENT:-

1. Treatment of predisposing or complicating factors
2. Parental counseling regarding-
   1. Benign and self-limiting nature of problem
   2. Need to provide an emotionally stimulating environment
   3. Supervision of the child
3. Behavioral modification strategies
4. Management should include education about general nutrition and may require iron therapy if a deficiency of this mineral is uncovered. Diagnosing and treating any underlying medical condition or complication such as lead poisoning is also important.

HOMOEOPATHIC MEDICINES:-

There are many Homeopathic medicines which have a promising scope in combating with this disorder. Few of those wonderful medicines used in homeopathic treatment for Pica are:

1. ALUMINA:- Delicate children who have been fed on artificial baby food and food products. Abnormal cravings for chalk,  charcoal, dry food, and raw uncooked rice. Children may suffer from painter’s colic. Has a tendency for constipation, hard knotty stool or with no desire for stool at all. Dryness is so marked that even the soft stool passes with difficulty.
2. CALCAREA CARB:- Children crave eggs and eat dirt, chalk, wall plaster, slate pencils, clay, raw potatoes and other indigestible things. Children normally are prone to diarrhea. Children are normally fat, flabby and fair. Children who grow fat, are large bellied, with large head, pale skin, chalky look.
3. CICUTA VIROSA:- Desires for unnatural things, like coal, or charcoal etc. Child puts coal into mouth, crunching, swallowing with apparent relish. Wants to eat raw potatoes. Indigestion, with insensibility, frothing at mouth. Hiccough and convulsions. Bending of the head, neck, and spine backwards, violent and strange desires.
4. CINA:- Predominantly a children remedy. Ill humor child, very cross, does not want to be touched, marked irritability. Desires many things, but rejects everything offered. Irritability full of temper, variable appetite, grinding of teeth, also has the tendency for worm infestations. Gets hungry soon after eating. Bores the nose with fingers till it bleeds. Craving for sweets.
5. LAC FELINUM:- Great desire to eat paper. Soreness of mouth due to extreme dryness. Natural stool but very slow in passing. Pain during bowels.
6. MERCURIUS:- Desires to eat cow dung and the mud of ponds. Violent tenesmus and continued urging after stool; a “never get done” feeling.
7. NATRUM SULPH:- Desire for ice and icy cold water. Thin, yellow fluid, gushing stools in the morning after rising and moving out. 
8. NITRIC ACID:- Great hunger, with sweetish taste in the mouth. Longing and craving for indigestible things like chalk, earth and paper etc. Irritable hateful, vindictive and headstrong children with dark complexion. Recurrent blisters and ulcers in the mouth.
9. PLUMBUM METALLICUM:- Child has typical habit of eating or biting the cloth, specially the collar of the shirt or the corner of the bed sheets. Abdominal wall feels drawn by a string to spine. Obstructed flatus, with intense colic. Constipation, stool hard and lumpy. 
10. SULPHUR:- Child eats discharge from nose. Child cannot bear to be washed or bathed. Weak, empty, gone feeling in the pit of stomach. Child falls asleep as soon as tenesmus ceases, after the stools.
11. TARENTULA HISPANICA:- Desires to eat ashes and also craves for sand. Desires for fruit, sour things or very cold drinks. Restlessness, cannot keep quiet in any position. 
12. VERATRUM ALBUM:- Craving to eat his own stool and drink his own urine. Vomiting and diarrhea with cold sweat on the forehead. Thirst for coldest drinks; wants ice. Constipated, stools hard and large size. Mania with desire to  cut and tear especially clothes.

Homeopathic system has a number of medicines specific for different type of cravings:

PICA, DESIRES TO EAT SAND, SLATE, EARTH, ETC., FOOD: 3Alum, 2Alumn, 3Calc, 1Calc-p, 1Chel, 1Cic, 1Con, 1Ferr, 1Hep, 1Hyos, 1Ign, 1Nat-m, 3Nit-ac, 2Nux-v, 1Oci, 1Psor, 1Sil, 1Sulph, 2Tarent

STRANGE, THINGS, DESIRES, FOOD: 1Alum, 1Atri, 2Bry, 2Calc,2Calc-p, 1Carb-v, 2Carc, 2Chel, 1Cic, 2Cycl, 2Hep, 2Lyss, 1Mag-c, 2Manc, 1Rheum, 1Sep, 1Ter

STRANGE, THINGS, DESIRES, FOOD, PREGNANCY, DURING: 2Alum, 1Calc, 1Carb-v, 2Chel, 3Lyss, 2Mag-c, 2Puls, 2Sep

The remedy abbreviations with

• 3 marks are quite effective,
• 2 marks are less effective,
• 1 mark are least effective.

CONCLUSION:-

Pica inspite of being just a minor eating disorder can cause major health ailments if left untreated. Homeopathic medicines are not only effective in the treatment of pica but works miraculously if indicated and prescribed accurately. 

REFERENCES:-

1. Paul K Vinod, Bagga Arvind. Ghai Essential. Ghai Essential Paediatrics. 8^th edition. New Delhi: CBS Publishers and Distributers Pvt Ltd.; 2014.
2. Jenson Kliegman Behrman. Nelson Textbook of Pediatrics. 16^th Edition, Book 2. Noida: Thomson Press (I) Ltd.; 2000.
3. Aggarwal Mukesh. Textbook of Pediatrics. 1^st Edition. Mumbai: Paras Printers (Bhalani Publishers) Ltd.; 2009.
4. https://familydoctor.org/condition/pica/
5. Gupta A. K . .The Problem Child and Homoeopathy. Noida : B. Jain Publishers (P) Ltd.; 2004
6. Das Rai Bahadur Bisambar. Select Your Remedy. New Delhi:  Indian Books & Periodicals Publishers; 2018.
7. Nash Eugene Beauharis. Regional Leaders. New Delhi: Books & Periodicals Publishers; 2003.
8. Allen H.C. Keynotes and characteristics with Comparisons of some of the Leading Remedies of the Materia Medica. 4^th edition. Philadelphia: Boericke and tafel; 1916  
9. Clarke John henry. A Dictionary of Homoeopathic Medicines. Volume 2. New Delhi: B. Jain Publishers (P) Ltd.; 2006.
10. https://www.welcomecure.com/diseases/pica/homeopathic-treatmentDr. Riya Kumar
    MD (Hom.) – Pediatrics (ongoing), Homoeopathy University, Jaipur
    under the guidance of Dr. Prasoon Choudhary HOD,