Pica

Key Points

• Pica is persistent ingestion of nonfood substances outside culturally normative practices.
• Common associations include iron deficiency, pregnancy, developmental disorders, and severe mental illness.
• Complications include poisoning, dental injury, infection, choking, bowel obstruction, and perforation.
• Treatment prioritizes medical safety, deficiency correction, and behavior modification.

Pathophysiology

Pica behaviors may emerge from nutrient deficiency, sensory reinforcement, stress coping, or learned family/community patterns. Repetitive nonfood ingestion can worsen nutritional deficits and cause toxic or mechanical injury.

Neurodevelopmental and psychiatric conditions can increase behavioral vulnerability. Clinical interpretation must separate pathological intake from culturally accepted nonfood practices.

Classification

• Deficiency-associated pica: Linked to iron, zinc, or other micronutrient deficits.
• Developmental/psychiatric-associated pica: Associated with autism, intellectual disability, schizophrenia, or OCD-spectrum features.
• Pregnancy-associated pica: Nonfood cravings with potential maternal-fetal toxicity risk.

Nursing Assessment

NCLEX Focus

Assess emergency complications first, then determine etiology and safety drivers.

• Assess ingested substance type, quantity, frequency, and access points.
• Assess acute danger signs: airway compromise, abdominal pain, fever, bleeding, or neurotoxicity.
• Assess nutritional deficiencies and anemia indicators.
• Assess developmental, psychiatric, and pregnancy-related risk context.
• Assess whether behavior is culturally normative or clinically harmful.

Nursing Interventions

• Remove access to hazardous substances and implement close safety monitoring.
• Coordinate urgent care for poisoning, obstruction, perforation, or sepsis concerns.
• Treat underlying deficiencies and monitor symptom response.
• Use behavior-modification and redirection strategies with caregiver reinforcement.
• Provide family education on prevention, supervision, and when to seek emergency care.

Hidden Toxicity Risk

Repeated ingestion of paint chips, soil, or contaminated materials can cause severe heavy-metal poisoning.

Pharmacology

There is no medication specifically approved for pica. Pharmacologic care targets underlying deficiency states or psychiatric comorbidity when present.

Nurses monitor response to mineral repletion and support adherence to nonpharmacologic behavior plans.

Clinical Judgment Application

Clinical Scenario

A pregnant client reports frequent clay consumption and fatigue, and has worsening microcytic anemia.

Recognize Cues: Persistent nonfood ingestion with pregnancy and deficiency risk. Analyze Cues: High concern for pica-related maternal-fetal toxicity and anemia burden. Prioritize Hypotheses: Prevent toxic exposure and correct nutritional compromise. Generate Solutions: Start deficiency treatment, exposure reduction, and close follow-up. Take Action: Implement education and family-supported prevention plan. Evaluate Outcomes: Verify reduced ingestion behavior and improved clinical markers.

Related Concepts

• avoidant-restrictive-food-intake-disorder - Overlapping feeding-behavior challenges in some clients.
• rumination-disorder - Differential feeding/eating condition with nutritional consequences.
• eating-disorder-risk-factors - Broader psychosocial and biologic vulnerability context.
• nursing-assessment-and-clinical-tools - Supports structured risk identification.
• collaboration-and-coordination-of-care - Needed for medical, psychiatric, and family integration.