Does my child have Pica?: Our Story

For the past few months I've had the nagging worry that something was not quite right with my almost- 4-year-old son, Benji. He would often say, "I feel sick" or "My tummy hurts." But because he would say these things before mealtime or bed time, I chalked it up to a rumbly, hungry tummy or feeling tired.

Still, that nagging worry remained. Because there was another issue I had to consider: He likes to eat non-food items, his favorite things being string, fabric, and paper products (toilet paper etc).

I had heard of Pica, the eating disorder where people crave and eat non-food items, but I thought, there is no way that is what is going on. A little online research revealed a list of things that Pica-eaters usually consume (dirt, clay, paint chips, plaster, chalk, cornstarch, laundry starch, baking soda, coffee grounds, cigarette ashes, burnt match heads, cigarette butts, feces, ice, glue, hair, buttons, paper, sand, toothpaste, soap) and, by golly, STRING was not on the list so we were safe.

Right?

To be EXTRA safe (or maybe just smart), I talked to my pediatrician about Benji's little habit a few weeks after it first started. He said that it might just be a phase but to keep an eye on him.

And I did. I watched him like a hawk. I never let him play by himself in another part of the house. I constantly told him "TAKE THAT OUT OF YOUR MOUTH!"

My litmus test for the "seriousness" of the situation was if he still had a BM regularly. Hey, if things were passing through then it was ok, right? Doesn't EVERY kid eat weird stuff? Admit it, we all went though a stage where we ate play-doh and the paper lolly-pop sticks. And a little dirt never hurt anyone.

Right?

I was determined that my son would not be the next "victim" of "My Strange Addiction."

We talked to Benji' constantly about not eating non-food items. We told him it hurt is belly. We told him it was no fun to poop string (no fun for mom and dad either. I will leave it at that). He would cry and repeat our mantras. However, we still would catch him again. And again. And his woven baby blanket, lovingly named "Blankie" kept getting bigger and bigger holes in it.

Finally, after weeks or realizing that "Blankie" was the main culprit behind the string addiction, my husband and I realized that we need to take some drastic measures. We got a new blanket (fleece, no strings) and put "Blankie" away for good. Benji made the transition quite well but it was still hard (for me, especially!)

What was "possessing" my child so much that he could not stop eating string (and other things)? Punishing, talking, threatening, monitoring wasn't working. I was constantly worrying.

And last Sunday (Sept 25), the crap hit the fan, as they say. Benji's twin brother Micah came in our room at 6am and told us that Benji had "Big Spits" (throwing up). A bit of close examination revealed that it was not the stomach bug that was going around pre-school. Benji was throwing up strings, fabric, plastic, and paper. We quickly called our pediatrician who (to make a long story short) told us to see if the vomiting stopped and then to call back to make an appointment at 9am (when the office opened). Poor Benji could not keep anything down--water, crackers, nothing--and threw up for 3 hours. We called the doctor again at 9am and he told us that we should go the ER in Roanoke (an hour 15 minutes away) to get checked out (the reason being that our hospital does not have a pediatric GI specialist).

We made our trek to Roanoke at 10am and were in the ER until 4pm. The doctor who saw us seemed to think we were "those" parents, to some extent. You know, the parents who are over-reacting and over-protective because Benji didn't throw up once while we were there and, in a weird moment of self-revival, joked and laughed with the ER doctor while being examined ("My belly is like "squishy play-doh!" he laughed).

And X-ray revealed that his little GI system was full 'o poop. Full. With little white objects floating around in it that looked like confetti. Like a party in his intestines.

"Very interesting," the doctor said. "Very interesting."

They took blood, gave him IV fluids, and a prescription for a laxative medication. "His iron is a bit low" was the result. So we headed back to Lynchburg with a very sleepy boy.

When we got home, our normally bouncing-off-the-walls boy just laid on the living room carpet in a tiny little heap. He was gray. We tried to get him to eat a little bit. We managed to get his first dose of meds in him.

Then, right as we were putting him to bed, the throwing up started again. And again. He was limp, so tired and sick he could barely keep his eyes open. We called Roanoke again and talked to the GI doctor (whom we had NOT seen earlier that day but who had been consulting the ER doctor) and he told us to come back--after hearing how Benji was doing, he thought that Benji should not have been released earlier.

It was 9:30pm by this point and we loaded the whole family into the car with a few blankets for the boys and a toothbrush for me (they talked about admitting us over night) and headed back to Roanoke.

After a few more hours in the ER we were admitted to a room on the pediatric floor at 2am. Poor Benji looked and felt horrible. He had another IV and was back in diapers rather than big-boy underwear. I slept (sort of) beside him in the fold-out chair all night. Aaron and Micah scored a room at the Holiday Inn Express for $125 (ouch).

Benji was officially diagnosed with Pica and we ended up staying in the hospital for four days. He had an endoscopy (under anesthesia) to check for blockages in his stomach. Thank God there were none but his bowel was impacted and he had to have 3 enemas in one day and many doses of Miralax.

Holy crap-o-la. Enemas work. When they finally kicked in, that poop was epic.

(Sidenote: Funny/sad story. After the enema-day was over, every time we heard another kid crying (which was frequently), Benij asked if they were getting medicine in their bottom. Poor kid. Then, one time I suggested we pray for a child who was crying in the room next to us. Benji said, "I'll pray. Dear God, thank you for him to feel better. Help him with the medicine in his bottom. Amen."I can't tell that story without laughing but still, poor little guy. The "medicine in the bottom" will not be forgotten).

It turned out the Benji was SEVERELY anemic. His iron level was at a 12. Normal range is 50-120. There is a theory that states that craving and eating non-food items is caused by iron deficiency. And like-wise, eating non-food items can cause iron-deficiency. A vicious cycle. Needless to say, we are hoping (and praying!) that by treating the anemia, we will help treat the cravings as well.

I wish I had asked the pediatrician to check his blood levels for low iron the first time I suspected pica. Maybe we could have started treating this sooner.

Of course, the next question that all parents would ask in this situation would be, how did my child get anemic in the first place? A unique situation came to our minds: Benji (and his twin brother) had his tonsils out at the beginning of the summer. Benji was one of the rare patients who had post-op bleeding (you can read about that "adventure" here). He lost a fair amount of blood that day but not enough to need a transfusion. But maybe just enough to make him anemic--and start the pica cycle. Just a theory on our part but, I believe, a logical one.

I realize that blood loss is a unique situation for most kids when thinking about the underlying "causes" of pica. Many children who have pica have other developmental challenges such as autism or mental retardation (neither of which are related to Benji). Some kids have OCD (we think Benji may be, a little bit) and like the taste and texture of non-food items. For other kids, there seems to be no rhyme or reason to why they start to eat "strange things."

This is what is so scary about pica. Parents want reasons. They want solutions--NOW. And a lot of times there seems to be nothing they can do.

The good news, for us, is that the enemas and laxatives worked and are working (Benji is still taking meds every day. We've been home from the hospital for exactly one week). Though we still have to monitor him closely and remind him not to eat string (etc), he has been able to poop every day and his appetite has sky-rocketed. In fact, he has gained one pound in one week. WOW! We are finally seeing 27 pounds on the scale (he is a tiny boy). He takes his iron supplement like a champ and when we have our follow up with the GI specialist on October 21st, I am sure the deficiency will be gone. (UPDATE: it took several months of iron therapy to reduce the deficiency).

I hope the cravings for string and other things will fade away with the anemia. That's the other good news: the vast majority of kids grow out of pica.

Thank God. I can now readily accept that my son has pica (a very real eating disorder) but I really don't want to be on "My (Child's) Strange Addiction."