Disorders usually first diagnosed in
infancy, childhood, or adolescence.
Feeding and Eating Disorders--

Pica
is an appetite for non-nutritive substances (e.g., coal, soil, chalk, paper etc.) or an abnormal appetite for some
things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch). In order for these
actions to be considered pica, they must persist for more than one month, at an age where eating such objects is
considered developmentally inappropriate. The condition's name comes from the Latin word for the magpie, a bird
which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women and small children,
especially among children who are developmentally disabled, where it is the most common eating disorder.

Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain
damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of
tetra-ethyl lead in gasoline or prior to the cessation of the use of contaminated oil (either used, or containing toxic
PCBs) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or
tearing in the stomach. This is also true in animals. Another risk of dirt eating is the possible ingestion of animal
feces and the accompanying parasites.

Causes

The scant research that has been done on the root causes of pica suggest that the majority of those afflicted tend
to suffer some biochemical deficiency and more often iron deficiency. The association between pica and iron
deficiency anemia is so strong, that most patients with iron deficiency will admit to some form of pica. Often the
substance eaten by those with the disorder does not contain the mineral of deficiency. If a mineral deficiency is not
identified as the cause of pica, it often leads to a misdiagnosis as a mental disorder.

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include:
discrimination training between edible and nonedible items, self-protection devices that prohibit placement of objects
in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste
(lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief
physical restraint, and overcorrection (correct the environment, or practice appropriate or alternative responses).

This involves associating negative consequences with eating non-food items and good consequences with normal
behavior. Medications may be helpful in reducing the abnormal eating behavior, if pica occurs in the course of a
developmental disorder, such as mental retardation, or pervasive developmental disorder. These conditions may be
associated with severe behavioral disturbances, including pica. These medications enhance dopaminergic
functioning, which is believed to be associated with the occurrence of pica.

Examples

* Amylophagia (consumption of starch)
* Coprophagia (consumption of excrement)
* Geophagy (consumption of soil, clay, or chalk)
o Consumption of dust or sand has been reported among iron deficient patients.
* Hematophagy (ingestion of blood)
* Hyalophagia (consumption of glass)
* Pagophagia (pathological consumption of ice)
* Self-cannibalism (rare condition where body parts may be consumed; see also Lesch-Nyhan syndrome)
* Trichophagia (consumption of hair or wool)
* Urophagia (consumption of urine)
* Xylophagia (consumption of wood)



Rumination disorder is an eating disorder in which a person -- usually an infant or young child -- brings back up
and re-chews partially digested food that has already been swallowed. In most cases, the re-chewed food is then
swallowed again; but occasionally, the child will spit it out.

To be considered a disorder, this behavior must occur in children who had previously been eating normally, and it
must occur on a regular basis -- usually daily -- for at least 1 month. The child may exhibit the behavior during
feeding or right after eating.

What Are the Symptoms of Rumination Disorder?

Symptoms of rumination disorder include:

* Repeated regurgitation of food
* Repeated re-chewing of food
* Weight loss
* Bad breath and tooth decay
* Repeated stomachaches and indigestion
* Raw and chapped lips

In addition, infants with rumination may make unusual movements that are typical of the disorder. These include
straining and arching the back, holding the head back, tightening the abdominal muscles, and making sucking
movements with the mouth. These movements may be done as the infant is trying to bring back up the partially
digested food.

What Causes Rumination Disorder?

The exact cause of rumination disorder is not known; however, there are several factors that may contribute to its
development:

* Physical illness or severe stress may trigger the behavior
* Neglect of or an abnormal relationship between the child and the mother or other primary caregiver may cause the
child to engage in self-comfort. For some children, the act of chewing is comforting.
* It may be a way for the child to gain attention.

How Common Is Rumination Disorder?

Since most children outgrow rumination disorder, and older children and adults with this disorder tend to be
secretive about it out of embarrassment, it is difficult to know exactly how many people are affected. However, it is
generally considered to be uncommon.

Rumination disorder most often occurs in infants and very young children (between 3 and 12 months), and in
children with mental retardation. It is rare in older children, adolescents and adults. It may occur slightly more often
in boys than in girls, but few studies of the disorder exist to confirm this.

How Is Rumination Disorder Diagnosed?

If symptoms of rumination are present, the doctor will begin an evaluation by performing a complete medical history
and physical examination. The doctor may use certain tests -- such as X-rays and blood tests -- to look for and rule
out possible physical causes for the vomiting, such as a gastrointestinal condition. Testing can also help the doctor
evaluate how the behavior has affected the body by looking for signs of problems such as dehydration and
malnutrition.

To help in the diagnosis of rumination disorder, a review of the child's eating habits may be conducted. It often is
necessary for the doctor to observe an infant during and after feeding.

How Is Rumination Disorder Treated?

Treatment of rumination disorder mainly focuses on changing the child's behavior. Several approaches may be
used, including:

* Changing the child's posture during and right after eating
* Encouraging more interaction between mother and child during feeding; giving the child more attention
* Reducing distractions during feeding
* Making feeding a more relaxing and pleasurable experience
* Distracting the child when he or she begins the rumination behavior
* Aversive conditioning, which involves placing something sour or bad-tasting on the child's tongue when he or she
begins to vomit

Psychotherapy (a type of counseling) for the mother and/or family may be helpful to improve communication and
address any negative feelings toward the child due to the behavior.

There are no medications used to treat rumination disorder.

What Complications Are Associated With Rumination Disorder?

Among the many potential complications associated with untreated rumination disorder are:

* Malnutrition
* Lowered resistance to infections and diseases
* Failure to grow and thrive
* Weight loss
* Stomach diseases such as ulcers
* Dehydration
* Bad breath and tooth decay
* Aspiration pneumonia and other respiratory problems (from vomit that is breathed into the lungs)
* Choking
* Death

What Is the Outlook for People With Rumination Disorder?

In most cases, infants and young children with rumination disorder will outgrow the behavior and return to eating
normally. For older children, this disorder can continue for months.

Can Rumination Disorder Be Prevented?

There is no known way to prevent rumination disorder. However, careful attention to a child's eating habits may help
catch the disorder before serious complications can occur.