Chewing!

Hi Robin, I can only imagine how very hard this must be for you. How severe is your son's pica? Sadly, it (when severe) is one of the most difficult (and rare) behavioral/medical issues that we saw in either community living or state residential placement, because every object is a potential danger. Everything from window coverings to tile grout is suspect to be picked/ pulled apart and ingested. In every instance of my experience the living environment had to be incredibly restrictive and sparse (plexiglass on walls to prevent paint/texture/sheetrock from being eaten; all personal items, toys, etc kept locked, only 1 item at a time out; few furnishings in private space where supervision was minimal; all clients when in the community were on a two to one staff ratio due to propensity to look for objects such as batteries, watches, would remove the strap and ingest the face, and cigarette butts. Naturally all of this was done with team discussion and approval of restriction.) And of course, the biggest concern aside from obstruction, is lead poisoning if you live in an older home or have older painted furniture) I presume that your son's pediatrician is aware and diagnosed the pica. Sometimes a really consistent behavior management plan of intervention is completely successful but really depends on the circumstances. (A suggestion: 1. choose a key word for your son and use it every single time that he appears to plan/or does eat something that is off limits, non edible. 2. if he ceases, provide him with a positive reenforcement that works best for him. If he attempts to eat the item, intervene. Use the chosen word and provide a preferred object as a redirection (preferably something he likes that is not edible, though you may, if no success, have to resort to trying an edible object later.) Sometimes the constant interruption and redirection really can help diminish the behavior. The first few days will be quite challenging and probably immensely irritating for him. I hope that helps even a little. Wishing you lots of luck. Take care.

Thanks for the reply. We have had this child only about 6mo. waiting for the TPR. The Pica was "sever" when he first came I thought it was major road rash by his pics! We have found that the Pica is usually under stress which is somewhat controlable but the constant need to chew is difficult. We have an appointment for a sensory eval thought maybe there is something lacking for the intense need for oral stim and chewing. Have you ever found this to be the case? All we have to do is say his name and he stops (momentarily) Popcorn has been the only thing so far. If there's anything else that you know that could shed some light on why these kids do this and or other behavior mod approaches, "PLEASE" let me know... Thank You again for your suggestions.

Robin, Pica was once widely believed to be the body's attempt (urge) to make up for vitamin deficiency, as it was often seen in pregnant women only temporarily. It has also been speculated that some kids/adults do it in an effort to stop a feeling of nausea. Nonetheless, the items that are eaten do not resolve the vitamin deficiency if there was one. In can be seen in the regular population but I believe that it is the most ongoing and certainly most severe in the MR (usually high functioning, Mild/Moderate) and Autistic population. Pica is absolutely not about oral stimulation; it is about ingesting. Most pica patients ingest quickly and do not self stim. They will sneak items, hide them, etc, and sometimes (not always) the size and danger of items increases. If your son is stopping when you call his name, though I would try to find another "catch" word, as you want his name to have a happy/interaction filled connotation for him, it could be a self stimulation activity and not really pica. Has he spent time in institutional care where maybe he was not stimulated or engaged? Self stimulation is not always necessarily a result of institutionalization (can be) or of lack of activity. It is very very common among MR kids. There is also some bit of controversy about it. If it is not dangerous, like head banging, or self injurious like chewing on fingers, etc. then many believe that it should be ignored and allowed. A behavior management program that introduces some relaxation elements daily (we had several techniques) and increases physical activity, reduces some stress may help; though it certainly may not. That program can combine the introduction of a new item that could become a preferred item, something that he might stim with but not ingest. Popcorn is good; of course, he cannot eat it all of the time, but when air popped with no butter and no salt, it is a good constant treat. I really hope that the sensory evaluation with the OT? can help.