FEEDING DISORDER OF INFANCY AND

CHILDHOOD & PICA

SUBMITTED TO: SUBMITTED BY

MS. MAHAK MATHUR RIVISHA SINGH
ASSISTANT PROFESSOR MSC CLINICAL PSYCHOLOGY( 2023-25)
 CONTENT

PICA REFERENCES
INTRODUCTION FEEDING DISORDER OF INFANCY AND CONCLUSION
CHILDHOOD 1. CLINICAL FEATURES
1. CLINICAL FEATURES 2. TYPES
2. TYPES 3. AETIOLOGY
3. AETIOLOGY 4. MANAGEMENT
4. MANAGEMENT 5. CASE STUDY
5. CASE STUDY .
 INTRODUCTION

•Feeding Disorder of Infancy and Childhood: This disorder is characterized by persistent disturbances in feeding or
eating that significantly impact a child’s health, growth, and psychosocial development. It typically presents before the
age of 6 and can lead to nutritional deficiencies, growth delays, and family stress.

•Pica: Pica involves the persistent ingestion of non-food, non-nutritive substances, such as dirt, chalk, or paper, which
is inappropriate for the individual’s developmental level. It can lead to serious health risks, including toxicity,
infections, and digestive issues.
 Importance of Recognizing and Treating These Disorders Early:
• Impact on Development: Feeding disorders can hinder physical growth, cognitive development, and social-
emotional well-being if left untreated.
• Role of Multidisciplinary Approach: Emphasizes the need for collaboration among healthcare providers, including
pediatricians, psychologists, dietitians, and family members, to effectively treat these complex disorders.
 FEEDING DISORDER OF INFANCY AND CHILDHOOD – CLINICAL FEATURES
• ICD-11 Classification: Feeding Disorder of Infancy and Childhood is defined by persistent disturbances in feeding and eating behavior that
interfere with a child’s health, growth, and psychosocial functioning.
• Age of Onset: Typically diagnosed before age 6, as feeding issues generally present in early childhood.
 Key Symptoms

1. Food Refusal or Restricted Intake:

1. Child may refuse to eat or severely limit the range of foods they are willing to consume.
2. May avoid certain textures, flavors, colors, or even temperatures of food.

2. Lack of Interest in Eating:

1. Some children display little to no interest in food or eating.
2. They may not respond to hunger cues or engage in mealtime.

3. Fear of Eating Due to Past Negative Experiences:

1. Children may associate eating with discomfort, such as choking or vomiting, leading to refusal or fear of food.

4. Inability to Self-Feed or Age-Appropriate Feeding Delays:

1. Delay in self-feeding skills (e.g., using utensils, managing solid foods) which impacts nutritional intake and independence.

5. Failure to Thrive and Physical Growth Delays:

1. Prolonged feeding disturbances often lead to malnutrition, delayed growth, and low body weight.
 TYPES OF FEEDING DISORDER OF INFANCY AND CHILDHOOD

 1. Avoidant/Restrictive Food Intake Disorder (ARFID)

• Definition: ARFID is a feeding disorder characterized by limited food intake due to a lack of interest in eating, avoidance
based on sensory characteristics of food, or a fear of negative consequences (e.g., choking, vomiting).
• Clinical Features:
• Selective Eating: Restricted diet with a limited range of foods, often avoiding entire food groups.
• Food Phobia: Fear-driven avoidance, often tied to previous traumatic experiences (e.g., choking).
• Impacts on Health: Can lead to malnutrition, significant weight loss, or failure to achieve expected weight gain in
children.
• ICD-11 Classification: ARFID is recognized as a specific feeding and eating disorder, distinct from other eating
disorders like anorexia.
 2. Sensory-Based Avoidance

• Definition: A type of feeding disorder characterized by extreme sensitivity to certain textures, smells, or
tastes, resulting in food refusal.
• Clinical Features:
• Food Texture Aversion: Rejection of foods based on texture, such as crunchy or mushy foods.
• Intolerance to Smells and Tastes: Strong reactions to certain odors and flavors, often causing immediate refusal.
• Commonly Observed In: Children with sensory processing issues or neurodevelopmental conditions (e.g.,
autism spectrum disorder).
• Impact on Social Behavior: Mealtimes can be challenging, with high levels of anxiety or distress
associated with specific foods, impacting family routines.
 3. Post-Traumatic Eating Difficulties

• Definition: Eating difficulties that develop following a traumatic experience related to food, eating, or
choking incidents.
• Clinical Features:
• Fear of Eating: Often includes an intense fear of swallowing, gagging, or choking, which can cause avoidance of
solid foods.
• Physical Symptoms: Children may experience physical symptoms like nausea or vomiting when presented with
certain foods.
• Associated with: Children who have experienced medical issues (e.g., prolonged hospitalizations) or
episodes that make eating feel threatening.
• Management Considerations: Focuses on gradually reintroducing foods in a safe, controlled environment
with therapeutic support.
 4. Limited Variety and Restrictive Eating

• Definition: Children with this type of feeding disorder consistently eat a very limited variety of foods,
which does not meet nutritional needs.
• Clinical Features:
• Monotonous Diets: Eating the same few foods over long periods.
• Resistance to New Foods: Strong reluctance or refusal to try new or unfamiliar foods.
• Health Risks: Risk of nutritional deficiencies, impacting growth and overall health.
• Differentiation from Normal Picky Eating: Unlike typical picky eaters, children with restrictive eating
face severe limitations that impact their development and health.
 AETIOLOGY
 1. Biological Factors

• Genetic Predisposition: Family history of feeding and eating disorders may increase susceptibility to
feeding disorders in children. Studies suggest a possible genetic link, though specific genes remain
unidentified.
• Neurodevelopmental Influences:
• Neurodevelopmental Disorders: Feeding disorders are more common in children with autism
spectrum disorder (ASD), ADHD, and intellectual disabilities. Sensory processing challenges in these
populations often contribute to restrictive or avoidant eating behaviors.
• Delayed Oral-Motor Skills: Delays in chewing or swallowing skills can lead to aversions to solid
foods, which may persist as selective eating behaviors.
• Physiological Conditions: Medical conditions like gastrointestinal reflux disease (GERD), food allergies,
or other digestive issues can cause pain or discomfort while eating, leading to food avoidance.
 2. Psychological Factors

• Anxiety and Fear Responses: Children with feeding disorders often associate eating with anxiety, which
can result from:
• Traumatic Experiences: Past experiences, such as choking, vomiting, or painful swallowing, can lead
to food aversion. This fear often becomes generalized, leading to avoidance of similar foods or eating in
general.
• Obsessive-Compulsive Traits: Children with high levels of anxiety or obsessive tendencies may
develop rigid eating patterns or fear of contamination, leading to restricted food intake.
• Attachment Issues: Parent-Child Interaction Problems: Feeding problems can emerge in children who
have experienced inconsistent or strained relationships with caregivers. This might lead to struggles for
control during meals or reluctance to try new foods.
• Early Feeding Practices: Overly controlling or overly permissive feeding practices can create problematic
eating behaviors, impacting the child’s ability to regulate food intake.
 3. Environmental and Social Influences

• Family Dynamics and Parenting Styles:

• Parental Anxiety: Caregivers’ anxieties about food intake or weight can sometimes result in increased pressure on
the child to eat, inadvertently causing the child to develop aversive behaviors.
• Modeling Behavior: Children often model eating behaviors observed in family members, which can influence
preferences, aversions, and mealtime behaviors.
• Cultural and Socioeconomic Factors:
• Cultural Norms: Some cultures place a high emphasis on particular eating behaviors, which can contribute to
rigid or restrictive eating in children. For example, emphasis on thinness or "clean eating" in some cultures may
lead to restrictive patterns.
• Economic Hardship: Limited access to a variety of foods or nutritious options can lead to inadequate nutrition
and may contribute to the development of feeding issues.
• Negative Mealtime Experiences:
• Disruptive Mealtime Environments: Loud, chaotic, or stressful mealtimes can make eating uncomfortable or
distressing, particularly for children sensitive to sensory input.
• Peer and School Influences: Social settings, such as school cafeterias, can contribute to feeding issues, especially
if children face teasing or peer pressure regarding their eating habits.
 MANAGEMENT

 1. Behavioral Interventions

• Focus: Behavioral therapy is a central part of treatment, aiming to modify feeding behaviors, reduce anxiety,
and increase food intake.
• Techniques:
• Positive Reinforcement: Rewarding the child for eating certain foods or trying new foods to motivate progress.
• Gradual Exposure: Slowly introducing new or avoided foods, starting with foods that are similar in texture or taste
to those the child already accepts. This helps desensitize food-related anxiety.
• Systematic Desensitization: In cases of food phobia, this technique involves pairing relaxation exercises with
exposure to foods that cause anxiety, helping the child tolerate them without stress.
• Token Economy: Reward systems where the child earns tokens for positive eating behaviors, which can be
exchanged for privileges or desired activities.
• Modeling: Parents or caregivers may model eating behaviors and express positive emotions about food to encourage
the child to engage in similar behavior.
 2. Family-Based Interventions
• Involvement of Caregivers: Family education and support are critical for addressing mealtime behaviors and
creating a consistent eating environment at home.
• Parental Training: Parents may receive training to implement structured mealtime routines, maintain calm, and
avoid reinforcing food refusal through negative responses like pressure or punishment.
• Parent-Child Interaction Therapy (PCIT): Focuses on improving communication between parents and children
during mealtimes, reinforcing positive interactions, and addressing underlying emotional challenges that may affect
feeding.
• Role of Family Support: Support groups or therapy for parents can help them manage stress and feelings of guilt
associated with their child’s eating issues.
 3. Nutritional Support
• Dietary Interventions: Addressing any malnutrition or vitamin/mineral deficiencies that may have developed due
to restricted food intake. This may include:
• Supplementation: Providing multivitamins or specific nutrients (like iron or zinc) if deficiencies are identified.
• Structured Meal Plans: Developing a structured eating schedule that includes balanced, nutrient-dense meals
and snacks to ensure proper growth and development.
• Consultation with Dietitians: A nutritionist or dietitian can work with families to create a food plan that meets
 4. Medical Monitoring and Interventions

• Addressing Underlying Medical Issues: A healthcare provider may investigate whether medical conditions (e.g.,
gastrointestinal issues, food allergies) are contributing to the feeding difficulties.
• Medical Examinations: A thorough assessment by a pediatrician or specialist to rule out organic causes
of feeding difficulties (e.g., oral motor problems, reflux).
• Tube Feeding (In Severe Cases): In some cases, when nutritional needs are not being met and growth failure is a
concern, temporary tube feeding may be used to provide adequate nutrition. However, this is often seen as a short-term
solution to stabilize health while behavioral treatments are pursued.
 5. Psychosocial and Emotional Support

• Therapy for Emotional and Behavioral Issues: Addressing any emotional factors that contribute to the feeding
difficulties, such as anxiety, stress, or trauma.
• Cognitive Behavioral Therapy (CBT): Can help children and parents cope with any anxiety or negative feelings
surrounding mealtime.
• Psychological Counseling: This may be indicated in cases where feeding disorders are associated with trauma or
attachment issues.
 6. ICD-11 Management Guidelines

• Individualized Care: Treatment should be tailored to the child’s age, the severity of the disorder,
and the presence of any co-occurring conditions (e.g., developmental disorders, autism).
• Continuous Monitoring: Regular follow-ups with the healthcare team to track the child’s progress,
update treatment plans, and address new challenges as they arise.
• Parental Involvement in Decision-Making: Engaging parents in setting goals, choosing
appropriate interventions, and reviewing progress regularly.
 7. Key Considerations for Effective Management

• Early Intervention: The earlier the intervention, the better the outcomes. Early identification of
feeding disorders allows for timely intervention to prevent long-term developmental and nutritional
deficits.
• Consistency and Patience: Treatment is often a gradual process, requiring significant patience
and consistency from parents and caregivers.
• Comprehensive Approach: Addressing feeding disorders requires more than just focusing on food
intake; the child’s emotional, psychological, and social development must also be considered.
 CASE STUDY
• Patient: 3-year-old female named Sarah (fictionalized name for confidentiality)
• Presenting Problem: Persistent refusal to eat a variety of foods, primarily accepting only certain textures (e.g., soft foods) and flavors.
• Primary Symptoms:
• Severe food selectivity, eating only a few specific foods (e.g., yogurt, bread, and applesauce).
• Refusal to eat any fruits, vegetables, or solid foods that require chewing.
• Mealtime behaviors include crying, tantrums, and spitting out food.
• Impact on Health: Low weight for her age, vitamin and mineral deficiencies, low energy levels, and compromised growth
trajectory.
 Diagnosis and Assessment

• Initial Assessment:
• Medical Evaluation: Conducted by a pediatrician to rule out physical conditions like oral-motor dysfunction or gastrointestinal
issues; no medical conditions were found that would explain the eating challenges.
• Behavioral Assessment: A behavioral psychologist observed Sarah’s mealtime behaviors and conducted interviews with the
parents.
• Diagnosis (ICD-11): Feeding Disorder of Infancy and Childhood, with features of Avoidant/Restrictive Food Intake Disorder
(ARFID).
• Contributing Factors:
• Sensory Sensitivity: High sensitivity to certain textures and tastes, common in young children with restrictive feeding behaviors.
• Anxiety at Mealtime: Child experiences anxiety around mealtimes due to pressure to eat and unfamiliar foods.
• Parent-Child Feeding Dynamics: Tension during meals due to parental frustration and attempts to force-feed or pressure the child.
 Treatment Approach

1. Behavioral Interventions
1. Positive Reinforcement: Sarah’s parents were taught to praise and reward any small progress in trying new foods, even if it was just a taste or
touching the food.
2. Gradual Exposure: Started with introducing foods similar in texture and color to those Sarah already accepted (e.g., pureed carrots as a step
toward other vegetables).
3. Modeling and Role-Playing: Parents ate new foods with Sarah to encourage her to try new items in a low-pressure way.
4. Desensitization Techniques: Used sensory play (e.g., touching and playing with food textures outside of mealtime) to reduce anxiety and
increase acceptance of varied textures.
2. Family-Based Interventions
1. Parent Training: Parents were trained on mealtime strategies, such as staying calm, avoiding pressure, and keeping mealtimes pleasant.
2. Establishing Routine: The family adopted consistent meal and snack times with limited duration (20-30 minutes per meal) to avoid
prolonged struggles.
3. Parental Support Sessions: Parents attended support sessions to address stress and guilt, as well as to share experiences with other families
facing similar challenges.
3. Nutritional Interventions
1. Dietary Supplementation: Prescribed a multivitamin to address her nutritional deficiencies until her diet could expand.
2. Structured Meal Plans: A nutritionist worked with the family to develop balanced meal options that included small amounts of
new foods alongside preferred foods.
 Treatment Progress and Outcome

• Progress Over 6 Months:

• Sarah gradually increased her food repertoire, eventually accepting a broader range of foods, including some fruits and vegetables,
as a result of consistent, gradual exposure.
• Reduction in mealtime anxiety and improvement in Sarah’s physical health indicators, including slight weight gain and improved
energy levels.
• Parents reported less stress during mealtimes and felt empowered by learning strategies to support Sarah’s eating in a positive way.
• Outcome Summary:
• Growth and Development: Sarah’s weight began to normalize, and her vitamin levels improved, reducing the need for
supplementation.
• Psychosocial Impact: Mealtime behaviors became more manageable, with reduced tantrums and anxiety, leading to a more positive
family dynamic.
• Long-Term Plan: The family continued with regular check-ins with the dietitian and psychologist to maintain progress and address
any new challenges as they arise.
 PICA – CLINICAL FEATURES

• Pica is defined by the persistent consumption of non-nutritive, non-food substances that is developmentally inappropriate
and lasts for at least one month.
• ICD-11 Classification: Classified as a feeding and eating disorder with potentially severe health risks due to the ingestion of
inedible substances.
 Commonly Ingested Substances

• Dirt/Clay (Geophagia): One of the most common forms, especially in young children.
• Paper, Chalk, and Crayons: Often found in school-age children.
• Hair (Trichophagia): Can lead to hairball (trichobezoar) formation in the stomach, requiring surgical intervention in severe
cases.
• Ice (Pagophagia): Sometimes associated with iron deficiency; frequent chewing on ice can lead to dental issues.
• Other Items: Paint, metal objects, plastic, and small toys are sometimes ingested, posing significant health risks.
 Key Clinical Features

1. Persistent Eating of Non-Food Items- This behavior is consistent and habitual, not limited to a single incident. It reflects a
compulsion to eat substances with no nutritional value, posing risks of toxicity and physical harm.
2. Physical Health Risks:
1. Toxicity and Poisoning: Risk of ingesting toxic substances like lead in paint or contaminated soil.
2. Digestive Issues: Blockages, constipation, or perforations in the digestive tract can occur, requiring immediate medical attention.
3. Dental Damage: Chewing hard substances (e.g., ice, metal) can cause enamel wear and fractures.
4. Infections and Parasitic Infestations: Ingesting contaminated substances increases the risk of bacterial infections or parasitic infestations (e.g., from dirt).

3. Psychosocial and Developmental Aspects:

1. Developmental Delays: Pica is often associated with developmental disorders such as autism and intellectual disabilities.
2. Nutritional Deficiencies: Pica may occur in conjunction with iron deficiency anemia or other micronutrient deficiencies, though it can also contribute to
worsening nutritional status if the intake of non-nutritive items replaces nutritious food.
3. Social Impact: Children with Pica may experience social stigma, particularly if their eating behaviors are noticed by peers or others.

4. Risk Factors and Contributing Conditions:

1. Developmental Disorders: Higher prevalence among children with autism spectrum disorder, intellectual disabilities, and certain sensory processing issues.
2. Psychosocial Factors: Environmental stress, neglect, and low socioeconomic conditions can contribute to the persistence of Pica.
3. Cultural Practices: In some cultures, the consumption of non-food items like clay or dirt has traditional meanings, although Pica goes beyond cultural
practices to involve persistent, compulsive behavior.
 TYPES OF PICA

 1. Developmental Pica

• Definition: Pica that commonly occurs in young children or individuals with developmental
disabilities, where non-food ingestion persists past the age at which it is typically outgrown
(e.g., around age 2).
• Clinical Features:
• Typical Substances Ingested: Dirt, clay, sand, small objects, crayons, etc.
• Age and Developmental Considerations: Often seen in younger children, but if it persists, it could indicate
an underlying developmental or behavioral condition.
• Associated Conditions: Higher prevalence in individuals with intellectual disabilities and
autism spectrum disorders.
• Health Risks: Increased likelihood of gastrointestinal blockages, poisoning, and other
physical health issues due to the ingestion of harmful substances.
 2. Nutrient Deficiency-Related Pica

• Definition: Pica driven by deficiencies in essential nutrients, often iron, zinc, or calcium,
leading the body to crave and consume non-food substances that may contain trace amounts
of these minerals.
• Clinical Features:
• Typical Substances Ingested: Soil, ice, starch, chalk, clay, which might contain minerals or provide a
temporary sense of satisfaction.
• Common Nutritional Deficiencies Linked to Pica:
• Iron Deficiency: Often results in a craving for ice (a behavior known as pagophagia).
• Zinc Deficiency: Linked to a broader range of cravings for soil and chalk.

• Mechanism: Pica behaviors may lessen as nutrient deficiencies are corrected.

• Health Risks: Ingesting non-nutritive substances can lead to toxicity, infection, or
gastrointestinal damage.
 3. Psychologically-Induced Pica

• Definition: Pica behaviors that emerge as a coping mechanism in response to stress,

trauma, or underlying mental health conditions, often associated with obsessive-
compulsive tendencies or severe anxiety.
• Clinical Features:
• Cravings for Unusual Substances: May include compulsive ingestion of items like hair
(trichophagia), soap, cloth, or paper.
• Psychiatric Correlates: Commonly co-occurs with conditions like obsessive-compulsive disorder
(OCD), schizophrenia, or other anxiety-related disorders.
• Compulsion vs. Craving: In many cases, the act is driven by compulsions rather than physical craving,
differentiating it from nutrient deficiency-related Pica.
• Health Risks: Potential for digestive obstruction, toxicity, or damage to teeth and gums.
 4. Culturally Influenced Pica

• Definition: Pica that occurs in specific cultural or regional contexts where certain non-
food substances are traditionally consumed due to cultural beliefs, often without harmful
intentions.
• Clinical Features:
• Substances Ingested: Clay, charcoal, and other natural substances thought to have health benefits.
• Cultural Practices: Found in certain regions or among particular cultural groups, where the behavior is
normalized rather than seen as a disorder.
• Psychological Component: Individuals may be influenced by cultural beliefs about the health benefits
of certain non-food items.
• Health Implications: While some culturally influenced practices are relatively benign,
there are potential risks if harmful substances are ingested regularly.
 AETIOLOGY

 1. Biological Causes

• Nutritional Deficiencies:
• Iron and Zinc Deficiency: Studies indicate a strong correlation between pica and deficiencies in
essential nutrients like iron and zinc. These deficiencies may prompt cravings for non-food items as the
body attempts to fulfill unmet nutritional needs.
• Other Mineral Deficiencies: In some cases, deficiencies in calcium or other minerals have also been
linked to pica behaviors.
• Correction of Deficiencies: Many individuals with pica show a reduction in the behavior when
nutritional deficiencies are addressed, highlighting the biological connection.
• Pregnancy-Related Changes:
• Pica is sometimes observed in pregnant individuals, possibly due to heightened nutritional needs and
hormonal changes that influence cravings for non-food items.
• Commonly ingested items during pregnancy-related pica include ice, clay, or starch.
 2. Psychological Factors

• Developmental Delays and Cognitive Impairments:

• Higher Prevalence in Autism Spectrum Disorder (ASD): Pica is more common among individuals
with ASD, intellectual disabilities, and other developmental disorders.
• Sensory Processing Issues: Some children with developmental delays experience sensory cravings or
find certain textures or substances calming or stimulating, which may explain their inclination toward
pica.
• Stress and Emotional Factors:
• Coping Mechanism: For some individuals, especially children and adults in stressful or neglectful
environments, pica behaviors may serve as a coping mechanism.
• Associated with Psychiatric Conditions: Pica is sometimes linked with psychiatric conditions like
obsessive-compulsive disorder (OCD) and schizophrenia, where it may be a form of compulsive
behavior.
• Childhood Trauma:
• Traumatic experiences or inconsistent caregiving in early life can increase the likelihood of pica as
children attempt to manage emotional distress through sensory stimulation.
 3. Social and Environmental Factors

• Cultural Influences:
• Cultural Acceptance of Certain Non-Food Items: In some cultures, the consumption of items like
clay or chalk has cultural or medicinal significance, which can normalize pica behaviors, especially in
specific geographic regions or within certain social groups.
• Environmental Deprivation and Neglect:
• Lack of Supervision: Children in neglected environments may have greater access to and opportunity
for ingesting non-food items.
• Association with Poverty and Malnutrition: Pica has been observed at higher rates in impoverished
communities, where nutrient-rich foods may be less accessible, contributing to nutritional deficiencies.
• Peer Influence and Imitation:
• Observational Learning: Younger children may imitate pica behaviors if they see siblings or peers
consuming non-food items, especially in close-knit or communal living situations.
 MANAGEMENT
1. Behavioral Therapy
•Focus: Behavioral therapy is crucial in managing Pica, as it addresses the underlying behaviors associated with consuming non-food
substances.
•Techniques:
•Positive Reinforcement: Rewarding the child when they avoid non-food items and choose appropriate foods instead. Reinforcement
encourages desirable behaviors and discourages harmful ingestion.
•Redirection and Distraction: Caregivers are trained to redirect the child’s attention when they attempt to eat non-food items, using
positive distractions like toys or safe activities.
•Response Prevention: Using consistent supervision to prevent access to unsafe items, especially in younger children who may not yet
respond to verbal instructions.
•Differential Reinforcement of Alternative Behaviors (DRA): Reinforcing specific alternative behaviors, such as eating snacks or
using sensory items (like chewing gum) instead of engaging in Pica behaviors.
 2. Nutritional Interventions
• Addressing Nutritional Deficiencies: Pica is often linked to deficiencies in essential nutrients such as iron, zinc, or calcium.
• Iron and Zinc Supplementation: Studies have shown that correcting deficiencies, particularly in iron and zinc, can reduce or
eliminate Pica behaviors in some cases.
• Balanced Diet Plan: A dietitian or nutritionist can create a meal plan rich in necessary vitamins and minerals, which can help curb
the urge to consume non-food items.
• Regular Monitoring: Nutritional deficiencies should be monitored periodically to adjust supplementation and dietary needs based on
 3. Medical Monitoring and Interventions:

• Health Risk Management: Given the potential dangers of ingesting non-food items (toxicity, blockages, infections), regular medical
monitoring is crucial.
• Physical Examinations: Routine exams to check for signs of gastrointestinal issues, dental damage, or toxicity (e.g., lead
poisoning from soil ingestion).
• X-rays or Imaging: In cases where there is concern for ingestion of harmful or sharp objects, imaging may be used to ensure no
internal injuries or blockages.
• Emergency Interventions: Ingesting toxic or sharp items may sometimes require immediate medical treatment or surgery.
 4. Psychosocial Support:

• Counseling for Emotional and Behavioral Support: Addressing any underlying emotional or environmental factors contributing to
Pica.
• Cognitive Behavioral Therapy (CBT): Useful in managing stress, anxiety, or compulsive tendencies that may be linked to Pica
behaviors, particularly in older children or adolescents.
• Family Therapy and Support Groups: Family therapy can provide parents and siblings with coping strategies and promote
understanding. Support groups may also offer insights and shared experiences from families facing similar issues.
• Education and Awareness: Educating caregivers, teachers, and other close contacts about Pica can reduce stigmatization and help
create a supportive environment.
 5. Use of Sensory Alternatives

• Sensory Substitutes for Oral Stimulation: Often, children with Pica crave oral stimulation. Providing safe alternatives
can fulfill this sensory need without the risks of Pica.
• Chewable Items: Sensory chew toys or jewelry can provide oral stimulation in a safe, controlled manner.
• Safe Edible Items: For children craving specific textures, incorporating safe edible items (e.g., crunchy
vegetables) into their diet can satisfy these cravings.
• Sensory-Based Activities: Engaging in tactile or sensory activities, such as play-dough or textured toys, may help
reduce the urge for non-food ingestion.
 6. Environmental Modification

• Creating a Safe Environment: Especially in younger children, controlling access to unsafe items is essential.
• Supervision: Close supervision during playtime and other activities helps prevent unsupervised ingestion of non-
food items.
• Removing Dangerous Items: Keeping harmful objects (e.g., small objects, sharp items, toxic substances) out of
reach can prevent accidental ingestion.
• Structured Play Areas: Setting up play spaces with safe sensory items that satisfy curiosity while preventing
access to unsafe items.
 7. ICD-11 Recommendations for Pica Management

• Individualized Treatment Plans: ICD-11 emphasizes that interventions should be

tailored to the child’s age, the severity of Pica behaviors, and any co-occurring
conditions.
• Continuous Monitoring and Assessment: Regular assessments of both behavioral
progress and physical health, adapting the treatment plan as needed.
• Family Involvement: ICD-11 suggests active family involvement in management
strategies, with an emphasis on training parents in behavioral interventions and
reinforcing safe environments.
 CASE STUDY
 Background Information

• Patient: 4-year-old male, “A.J.”

• Presenting Issue: A.J. has been observed eating non-food items such as dirt, chalk, and paper for
approximately six months.
• Developmental History: A.J. has a normal developmental history with no known intellectual or
developmental disabilities. However, he comes from a low-income family with limited access to a balanced
diet.
• Family Background: A.J.’s mother reports that their family meals are often repetitive and consist mainly of
staple foods, with limited fruits, vegetables, or meats.
 Clinical Assessment

• Initial Symptoms and Observations:

• Persistent consumption of non-food items (primarily dirt and chalk).
• Episodes of abdominal discomfort and constipation.
• Diagnosis: Based on the symptoms, clinical assessment, and behavior patterns, A.J. was diagnosed with Pica, as per ICD-11
criteria. The persistent ingestion of non-food items for at least one month, along with the medical consequences, met the diagnostic
criteria.
 Etiology and Contributing Factors

• Nutritional Deficiencies: Iron and zinc deficiencies were significant contributing factors to A.J.'s pica behavior. Iron-deficiency
anemia has been linked to cravings for non-food substances as the body seeks to compensate for nutritional shortfalls.
• Environmental and Socioeconomic Factors: Limited access to diverse foods may have compounded A.J.'s nutritional
deficiencies, making non-food items appealing.
• Family and Environmental Stress: The family’s limited resources and lack of dietary variety may have contributed indirectly to
A.J.’s behavior.
 Treatment and Intervention

1. Nutritional Intervention:
1. Iron and Zinc Supplementation: A.J. was prescribed iron and zinc supplements to address his deficiencies and improve his
overall nutritional status.
2. Dietary Modifications: A dietitian worked with A.J.’s family to create a balanced meal plan that included iron-rich foods
like lean meats, leafy greens, and fortified cereals. Foods high in vitamin C were recommended to enhance iron absorption.
2. Behavioral Therapy:
•Positive Reinforcement: A system of positive reinforcement was introduced, rewarding A.J. for choosing food over non-food
items. He was given stickers and small rewards for each day he refrained from eating dirt or chalk.
•Substitution Technique: Safe, chewable items like crunchy vegetables were offered as alternatives when A.J. expressed
interest in eating non-food items, helping redirect his behavior in a safer way.
•Parental Guidance: A.J.'s parents were educated on how to monitor and manage his behavior. They were encouraged to keep
non-food items out of reach and redirect his attention to safe activities.
3. Family and Environmental Support:
•Parental Counseling: A counselor worked with A.J.’s parents to address family stress and enhance coping strategies, which
helped in creating a more supportive home environment.
•Educational Support: A social worker assisted the family in finding resources for affordable, nutritious food options in their
area, providing information on food banks and community programs.
 Outcome

• Behavioral Improvement: Within three months, A.J. showed a notable reduction in pica behaviors. He no longer sought out
chalk and dirt and instead accepted safe food alternatives.
• Health Improvements: Follow-up blood tests indicated that A.J.’s iron and zinc levels had returned to normal. His physical
symptoms, such as fatigue and pallor, improved, along with better energy and focus.
• Long-Term Plan: A.J. continues to attend regular check-ups to monitor for any recurrence of pica behaviors. The family
continues to receive nutritional guidance and support for maintaining A.J.'s dietary needs.
 CONCLUSION

 Feeding Disorder of Infancy and Childhood and Pica are complex conditions with significant impacts on a
child’s physical, emotional, and social well-being. Early diagnosis and intervention are critical, as they prevent
health complications, address nutritional deficiencies, and support healthy development. Successful
management relies on a multidisciplinary approach, involving collaboration among healthcare professionals
and a strong emphasis on family involvement. Caregivers play a crucial role in implementing structured
mealtime routines, reinforcing positive behaviors, and providing emotional support, making their education and
empowerment essential components of treatment.
 Ongoing monitoring and regular follow-ups are necessary to track progress and adapt treatment to the child’s
changing needs. Ultimately, a holistic approach—considering both the medical and psychological aspects—
leads to better outcomes and a higher quality of life for both the child and family. Empowering caregivers in
this process is key to creating a supportive, sustainable environment for the child’s long-term well-being.
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