A step-by-step guide on how to help a child with pica who craves non-edibles
Children are naturally curious. At a young age, it’s common to see them put toys or other non‑edible objects into their mouths as they explore the world. But when a child continues to eat things that aren’t food, it can quickly become worrying and even quite dangerous. If a child craves and eats non‑food items for more than a month, this behavior is known as pica.
Understanding the signs and symptoms, along with the step-by-step approaches that can help, empowers you to guide your child toward safer habits and supportive care.
Understanding the Signs & Symptoms of Pica
Signs of pica in children include craving and eating non-food items for over a month. These items may include dirt, clay, rocks, paper, ice, crayons, hair, paint chips, chalk, or even feces.
How are Sensory Processing Disorders and Pica Related?
Sensory processing plays a major role in a child's daily life, especially when it comes to eating. When a child has trouble taking in and responding to sensory information, this is called sensory processing disorder. Some children react very strongly, while others react very little, and both can lead to strong food reactions, food aversions, or sensory needs like craving oral stimulation.
This is one reason some children may find comfort in eating non-edible items. The oral stimulation provides sensory feedback that may feel good and may help their bodies regulate.
These sensory needs can relate to oral fixation, which we often see in children 2 and under as they soothe themselves, deal with teething, and get sensory relief. This is why pica is not diagnosed before age 2, since these behaviors are somewhat typical in early development.
For children older than 2, who are becoming more confident with feeding themselves, eating non‑edible items may become a way to cope with stress or anxiety. However, it is not a safe behavior, and this is the age when pica can be diagnosed.
Intellectual Disabilities and Autism Co-occurrence With Pica
Research suggests that intellectual disabilities, developmental delays, and autism are often accompanied by sensory differences. Children with unique sensory needs may sometimes try to meet those needs by chewing on or eating non-edible items.
When we understand a child's sensory needs, it helps us understand why conditions like autism and other intellectual disabilities can sometimes co-occur with pica, and which interventions may subsequently help the most.
What Can You Do to Help a Child With Pica?
(1) Behavioral interventions:
Behavioral interventions are used to replace pica behaviors with safer alternatives. Research has used Applied Behavior Analysis (ABA) to understand unwanted behaviors better, and work towards increasing helpful behaviors while decreasing the harmful ones. ABA can be adapted to meet your child's personal needs.
For example:
Noncontingent reinforcement involves adding safe, appealing items to your child's environment, such as toys or safe foods, that can draw the child’s attention away from non‑food items.
Differential reinforcement uses rewards to teach appropriate behaviors, such as giving the non-edible item to the therapist or parent, or throwing it away. It also includes participating in other activities instead of engaging in pica.
(2) Create a supportive environment
A supportive environment can make all the difference. Keeping the child’s preferred non-food items out of reach, using locks on cabinets, and making sure your child has access to safe toys and activities they enjoy can help create a safe and engaging space.
Pica can be used as a coping strategy for stress or anxiety, and can be related to developmental or intellectual disabilities. Creating a supportive environment and a consistent, dependable routine can also help your child feel safer and promote positive behavior changes.
(3) Provide sensory support
Children who eat non-edible items often seek specific sensory feedback. To meet those needs in a safe way, consider offering appealing alternatives, like vibrating toys, crunchy foods, or a vibrating toothbrush.
Sensory food play can also be a fun and engaging way to support eating and provide sensory relief.
Tips and tricks used by other parents:
A former client of mine used a “sour spray,” recommended by a feeding therapist, to spray on the child’s preferred non-edibles. This made the items taste sour and unpleasant, which served as a deterrent and also as a reminder for the child, in case they were drawn mindlessly to eating non-edibles while thinking about something else.
Connecting with a feeding therapist who understands your child is a helpful way to develop a personalized pica prevention plan tailored to your child’s needs.
Replacing the non-edibles with safe foods can provide the sensory support and relief they are seeking. Below are some examples of non-edible to edible swaps that may be helpful.
Non-edible craving → appropriate swap:
Dirt → crushed pretzels or crackers over yogurt or with milk
Crayons → freeze-dried fruits or vegetables
Paint chips → rice paper or seaweed snacks
(4) Nutritional interventions & dietary adjustments for pica:
The causes of pica are not well understood, but nutritional deficiencies such as low iron or zinc can exacerbate symptoms of pica and increase a child's risk for developing it.
We know pica can lead to health and nutritional concerns. When a child is not getting enough nutrients from food and is instead eating non-edible items, nutrient deficiencies and related health concerns can develop. These include iron deficiency anemia, lead poisoning, constipation, diarrhea, intestinal infections, intestinal obstructions, and dental injuries.
As a part of a treatment plan for pica, it can often help to address a child’s nutrient deficiencies first, through targeted food choices or supplements under the care of a pediatric dietitian, as nutrient deficiencies can often be a meaningful part of what is driving the behavior.
When and Where to Seek Medical Advice for Pica
If pica symptoms last longer than a month, or if you are concerned by pica-related behaviors you are seeing regularly, consult your pediatrician, pediatric dietitian, or behavior specialist. With the potential for health and nutritional concerns, your child should be medically evaluated asap to help prevent possible long-term health consequences.
A Case Study: Using a Team-Based Approach to Help Manage Pica
The mother of a 7-year-old child reached out to me recently about nutrition counseling with concerns about picky eating and pica. The boy had a history of eating non-edibles, picky eating, and nutrient deficiencies, and the pica-related behaviors would worsen during periods of heightened anxiety.
A multidisciplinary approach involving the child’s pediatrician, mental health specialist, occupational therapist, and pediatric dietitian worked well. We collaborated with the family to expand the child’s diet, manage his anxiety, teach healthier, alternative, anxiety-reducing behaviors, fill nutrient gaps that were contributing to his pica tendencies (most notably iron), and strengthen his caregivers to create a safer environment.
Checking for nutrient deficiencies can be an important early step when a child shows signs of pica. Sometimes correcting the deficiency is enough to melt away the pica behaviors, and for other children, filling nutrient gaps helps increase the effectiveness of other multi-disciplinary therapies.
Resources and Final Thoughts
If your child is showing signs of what you think may be pica, or if you are unsure about their behavior, reach out to your medical support team. Consult with your pediatrician, and try to connect with a pediatric dietitian or feeding therapist who has experience working with children with pica. Eating disorders such as pica can be hard for both the child and the parent, and the sooner you can involve your medical support team, the faster the behavior will improve.
*Note: If you believe your child may have eaten something harmful or is choking, seek medical care or call poison control at (800) 222-1222.
Thank you to my dietetic intern, Ruthie Grant-Williams, for her contributions to this blog post.