-Dr. Arvind Dubey
Earth eating or eating
and/or craving for abnormal edible objects in technical terms in known as
‘Pica’. It is very commonly encountered
in common day-to-day practice and everywhere remains a cause of concerns for
mothers especially who are conscious of their child development to an extent.
Even being a very common problem of childhood, Indian literature shows a
paucity of accurate information about it, especially for non-medical masses.
Word ‘Pica’ is derived from
a Latin word “Magpie” meaning a bird famous for its habit of stealing unnatural
object for food commonly found inedible to general categories of birds.
Avicenna in 1000 AD brought
attention of general public to this problem and presumed that probably it was
due to some deficiency in diet especially Iron and also described benefit of
iron preparation in treating it.
Recently this disorder had given full regards by putting it in separate
category of habit disorders and by explaining accurate criteria for defining
the disorder, which states “evidence of regular eating of non edible substances
for at least one month.
Though this disorder has
been evaluated to greater depth yet exact cause and factors responsible for it
are still debatable. When child is born his world of experience uses to be very
limited. As he grows, it expands through
the process of exploration. According to
concepts of psychological development, first erotic zone developed in early
life is “oral one”. So at this stage all
the pleasures are associated with this zone and obtained by mouthing any thing
comes in the way to child but it is supposed to be normal unto age of 18 month
to 2 years. But if this extends beyond
this age and becomes a regular feature then it is to be investigated and may be
considered as a health hazard. Though
this habit of eating abnormal things such as clay, mud, ash etc is also found
in pregnancy but it is not supposed as health hazard because it is temporary
and due to some established substantial deficiencies and increased levels of
some hormones during pregnancy that ceases when the things come to the normal
after pregnancy. Though being a regular
eating of these things more than 1 month it comes under boundaries to be
diagnosed, as ‘Pica’ yet never needs investigation.
As such few defficiency
states for certain substances blamed Widely for this disorder and important one
from these was iron and some time calcium and magnesium also. People tried to
treat this disorder by injectable iron preparations and results were good but
probably due to fear of injections in a child.
In some tribal areas and in
some underdeveloped countries such as Rhodesia ,
some Portuguese tribal areas, East, North & West Africa
and Congo ,
earth eating is a common practice. There
it is usually associated with religious and magical belief of natives. On entering alien soil an African may eat a
little of it’s soil as an act of homage.
His wife, children and even the baby must also partake in this
rite. It is also believed that if a
woman eats earth before pregnancy she becomes more fertile and by continuing to
eat, it increases her power of lactation.
Some social factors play
vital role in development of this disorder.
Large facilities with inadequate resources to take care of that large
family’s needs, uninformed parents, and inadequate child care due to family
disorganization, marital disharmony, unmarried mother, working mothers etc. are
the important ones. Poverty also plays
an important role in development of this habit but the factor causing it may be
poor nutrition, inadequate attention to child due to ignorance, psychosocial
environment or all of these.
Psychological stresses are
supposed to be the mainstay of causation.
This includes, recent arrival of new sibling or pregnant mother,
maternal illness or hospitalization, hospitalization or recent illness of child
himself, separation from mother father or from grand parents. Frequent change of residence also affect
child’s attitude a lot and may initiate earth eating in a previously normal
child.
As it has already been
stressed that oral exploration is a first mean used by child and young animals
to understand the outside world. In
children these oral patterns of behaviour gradually become restricted to the
feeding situation, towards the end of 1st year.
This is high time. At this stage some defect in oral fixation or
disturbed behaviour or orality may lead to this disorder and so may be associated
with pacifiers, thumb seeking prolonged bottle or breast-feeding.
Organic brain damage due to developmental
causes, cause related to birth events such as delay in first breath etc. has
also been blamed as a causative factor in development of this habit and
unfortunately it form a self complete circle of events. A mentally retarded child has greater
dependency on parents. If it is not fulfilled either due to ignorance or due to
aversion to child, this oral activity as an alternative for satisfaction persists. On consumption of paint as an abnormal food
object, the lead of this paint may cause further brain damage and complete the
circle.
Some times loss or
inevitable sharing of a loved object produces an internalized hostility, which
in turn may be projected as earth eating.
General environmental situations which may also lead to this perverted
eating include poor housing, houses painted by lead containing paints, children
of parents, who had earth eating as a problem in their childhood and children having
playmates with this perverted appetit
This problem is
most prevalent in the age group of 1-3 years (on an average 2-3 years of age)
and children in nuclear families. If one
child in the family having this disorder the chances of another children to
have this disorder increase manifold.
Dirt eating is more common
in male children, which is probably due to preferential concern of parents to
male children in this part of country. Prferentially more number of male
children in comparison female children is taken to the doctor for treatment of
this problem.
The substances which are
eaten in this habit includes dirt, mud, sand, earthen pottery, wall plaster,
coal, chalk, ash, candles soap paper, agarbatties, cow dung, cement, plastic
goods etc. Among these eating dirt, mud,
earthen pottery, sand and chalk are more common.
In one study conducted at
various places, it was found that there are so many erroneous concepts of
parents regarding causation of this habit.
These include worms, hereditary factors calcium, iron, deficiency, evil
spirit, and ingestion of worms during play or some unknown causes etc.
This disorder manifests
itself in many ways but anaemia, and malnutrition is the important ones but it
is still doubtful that malnutrition itself is a cause or manifestation of this
disorder. Not all the children with this
perverted eating habit have malnutrition though most of them manifest in this
way. Worm infestation is also a leading
complaint among such children. This in
turn may lead to anaemia and malnutrition because each worm sucks around 0.2 ml
of blood per day from intestine. When
children ingest wall plaster they may develop lead poisoning due to lead
constituent of paint. The children enjoy
eating clay and earthen pottery may be deficient for zinc.
Most of the children with
this habit have a number of associated behaviour problems. Every child with perverted appetite should be
expected to have some behaviour problem particularly if he has an aggressive
nature. Most of these behavioural
problems are in the form of aggressive reactions, for example – temper
tantrums, bruxism, and breath holding spells, head banging and nail biting etc.
Continuous swallowing of hairs and vegetable fibers may lead to “Trichobezarre”
and “Phytobezarre” respectively. These
later on may present as intestinal obstruction. Swallowing of stones and may
cause intestinal perforation and even death.
Though these complications are rare now a day due to advent of modern
surgery.
Treatment of such common
habit is rather tedious. Due to
ignorance in its initial stage it usually never taken seriously. As defective mothering is supposed to be a
very important cause of it so manipulations here lead to abatement of this
perverted eating habit. This can be done
by changing the pattern of relationship in such a way that child start feeling
himself secure and an important part of family.
Due attention has to be paid to his works his hobbies and interests so
he may not need an extra instrument to attract the attention of others by this
habit. Environment and surrounding can be changed.
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