Most people know that babies and toddlers are always putting things in their mouth, and this is a normal stage of oral development. Some children continue to chew on non-food items well past the mouthing/teething stage.

For some, it’s a passing phase, and for other individuals, there’s a continued need to chew and this may continue to adulthood. This continued need may have many different reasons as Debra C. Lowsky suggests in

The most common reason for excessive chewing is for relief of stress or anxiety. Chewing can be extremely calming and organizing. It’s similar to biting fingernails, pacing or tapping your foot.

Pica is defined as the need/craving to not just chew but to eat non-food items (paper, clay, sand, rocks, ice, hair, paint chips and even feces). Pica (PIE-kuh) is an eating disorder usually defined as the persistent intake of nonnutritive substances.

To fit the definition, this craving has lasted for longer than a month and happens in persons who are old enough to know better, not toddlers. Pica can start in childhood. Needless to say, some of the things that are eaten aren’t dangerous while others could be life threatening.

Doctors don’t know exactly what causes pica. It’s more common in people with developmental problems, mental health problems such as obsessive-compulsive disorder or schizophrenia. It may be caused by malnutrition or hunger as non-food items may give a feeling of fullness.

Interestingly, low levels of nutrients like iron or zinc might trigger specific cravings. Obsessive chewing of ice is associated with iron deficiency. Stress also is a cause as pica is often seen in children living in poverty and sometimes in children who’ve been abused or neglected.

Determining the consequences of pica are highly variable and depend on what’s being eaten. It can be one substance such as clay or starch or anything available.

One of the most concerning is the possibility of having ingested lead. Lead is already routinely screened in children aged 1-2 years in localities where at least 27 percent of houses were built before 1950, in places where elevated blood levels is 12 percent or higher, and in high-risk 1- to 2-year-old children because of the tendency of young children to put everything in their mouths.

Intestinal problems may range from the simple, such as constipation, to more serious problems like obstruction or ulcerations, to life-threatening hemorrhages and perforations.

Treatment for excessive chewing might be a safe chew tool such as wearable “chewelry,” which are non-toxic and safe for teeth or may require treatment from an occupational therapist to put together additional strategies.

Treatment for pica would include correction of any nutritional deficiencies, consulting a psychologist for behavioral strategies and/or consulting a social worker to help determine social problems.

There’s some evidence that some medications that enhance the function of dopamine, one of the neurotransmitters, can help with those individuals resistant to behavioral therapy. There’s no medical treatment specific for pica.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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