Understanding Pica in Children with Autism: What It Is and How to Support Your Child

Today, I'm diving into a topic that affects many children on the autism spectrum: pica. If you’ve noticed your child eating non-food items like dirt, paper, or small objects, you’re not alone. Let’s explore what pica is, why it’s more common in autistic children, the potential risks, and most importantly, how you can support your child through it.

What Is Pica?

Pica is an eating disorder characterized by the persistent craving and consumption of non-nutritive, non-food substances for at least one month.    The name comes from the Latin word for “magpie,” a bird notorious for eating just about anything. Common items ingested include dirt, clay, paint chips, hair, paper, chalk, or even feces—things that provide no nutritional value and can be harmful.

While it’s normal for toddlers under 2 to mouth objects as part of exploration, pica is diagnosed when this behavior continues beyond that age, is developmentally inappropriate, and isn’t part of a cultural or religious practice.   It’s estimated to affect 10% of young children in general, but the prevalence jumps to up to 28% in those with autism spectrum disorder (ASD) or other developmental disabilities.  

Why Is Pica More Common in Children with Autism?

Children with autism often experience sensory processing differences, which can make certain textures, tastes, or sensations irresistible. Pica may stem from a need for sensory input, like the crunch of gravel or the smoothness of paper. 

Other contributing factors include

•  Nutritional deficiencies: Low levels of iron, zinc, or other minerals can trigger cravings for non-food items. Many autistic children are zinc-deficient, which can exacerbate pica along with picky eating. 

•  Gastrointestinal issues: Studies show a link between pica and GI symptoms in autistic kids, possibly due to discomfort or malabsorption. 

•  Stress, anxiety, or boredom: Pica can be a self-soothing behavior in response to overwhelming environments or emotional needs.  

•  Co-occurring conditions: It’s often seen alongside intellectual disabilities, OCD, or schizophrenia. 

Understanding these root causes is key to addressing pica effectively, as it’s not just “bad behavior” but a signal of unmet needs.

Risks and Complications of Pica

While pica might seem harmless at first, it can lead to serious health issues, making early intervention crucial:  

•  Poisoning: Ingesting items like paint (which may contain lead) or chemicals can cause toxicity. 

•  Infections and parasites: Dirt or feces can introduce bacteria, worms, or other pathogens. 

•  Digestive problems: Blockages, constipation, tears in the intestines, or malnutrition from displaced nutrition. 

•  Dental and physical injuries: Sharp objects can damage teeth, mouth, or cause choking. 

•  Long-term effects: Untreated pica can contribute to developmental delays or exacerbate autism-related challenges. 

In autistic children, pica is considered one of the most dangerous self-injurious behaviors, potentially leading to emergency situations.  

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How to Support Your Child with Pica

The good news is that pica is treatable with a multifaceted approach. Always start by consulting your child’s pediatrician or a specialist to rule out medical causes and get personalized guidance.    Here’s how you can help:

1. Medical and Nutritional Assessment

•  Get blood tests for deficiencies (e.g., iron, zinc) and supplement as recommended. 

•  Screen for GI issues or lead poisoning with X-rays if needed. 

2. Behavioral and Sensory Interventions

•  Applied Behavior Analysis (ABA): Use positive reinforcement to encourage safe alternatives and discourage pica behaviors.  

•  Sensory Integration Therapy: Provide “sensory diets” with safe items like chewy toys, crunchy snacks (carrots, ice), or textured fidgets to satisfy cravings.  

•  Create a “pica box” filled with edible or safe textured items to redirect urges.

3. Home Safety Measures

•  Childproof your environment: Remove or secure tempting items with locks, barriers, or high shelves. 

•  Increase supervision and track patterns in a journal to identify triggers. 

•  Educate family and caregivers to respond calmly and consistently.

4. Therapy and Medication

•  Occupational therapy for sensory needs or cognitive behavioral therapy for anxiety. 

•  In severe cases, medications like antipsychotics may help reduce compulsions, but only under medical supervision. 

Many children outgrow pica with intervention, especially when addressed early. Be patient and celebrate small wins.