Pica: Common but Commonly Missed

, , and , Department of Family Medicine, Wayne State University, Detroit.

J Am Board Fam Med. 2000;13(5) 

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The term pica comes from the Latin word meaning magpie, presumably named after this bird's peculiar eating behaviors. The magpie shows an indiscriminate preference for foods and nonfoods. Pica of dirt and clay was known to the Greeks and the Romans and was recorded in a 13th century Latin work. Pica was first addressed in a medical book in 1563, where geophagia was described in pregnant women and in children.[2]

Pica behavior still occurs almost ritualistically in some modern cultures. Geophagia has been described as a common act during the 1800s in the southern United States, primarily among slaves, and is still an accepted behavior in many cultures. It has been practiced as part of religious ceremonies, magical beliefs, and attempts at healing.[2] Clay ingestion has been used for medicinal purposes by many cultures, possibly to affect the microorganisms in the gut or to help relieve intestinal spasms. During the 1950s and 1960s, geophagia was so common in the south that one could purchase small brown bags of clay outside bus stops. As members of the southern population moved north, it was not uncommon to have special local clays mailed from family members back home.[5,6,7]

Pica has frequently been described as a symptom of iron deficiency, although it occurs often in those who have normal hemoglobin levels.[1,2,3,4,8,9] In the late 1960s, articles in medical journals documented the association between ice eating and anemia and its subsequent relief with iron treatment, although whether pica caused the anemia or the anemia caused pica remained unclear.[2] Ice eating in particular seems most closely tied to iron deficiency and seems to be most consistently amenable to iron therapy. The other forms of pica, however, have been much more inconsistent in their response to iron or any other mineral therapy.


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