PICA & Ruminaton Disorder of Infancy

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Pica is the persistent (more than 1 month) ingestion of nonnutritive substances inappropriate for developmental age and unacceptable as cultural practice. Pica encompasses a wide variety of populations including toddlers who eat paint chips, pregnant women who consume starch and clay (the two largest groups), severely retarded children and adults who eat feces, and anxious adults who chew fingernails or pencils. Pica may be caused by poor nutrition, mineral deficiencies, or psychosocial deprivation. The condition is very responsive to nutritional and psychosocial intervention.

Rumination is a rare syndrome of infancy in which swallowed food is repeatedly returned to the mouth, pleasurably sucked on or rechewed, and then swallowed again. Rumination disorder is apparently caused by severe physical and emotional neglect, since it readily responds to substitution of caretakers. The behavior may be the deprived infant’s attempt at self-stimulation. Rumination behavior has also been reported in adults, where it is usually associated with stress, such as acute medical illness or surgery, losses, such as a death in the family or being fired from a job, or psychiatric illness, such as depression. Effective treatments include biofeedback and relaxation exercises. Treatment for the associated stress disorders and depression with psychotherapy and/or psychopharmacology is also effective in reducing rumination behavior.

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