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Abstract Normal feeding and eating depends on the successful integration of a range of physical functions and interpersonal relationships during early development. Disruption in one or more of these multi-system areas can result in a feeding problem (Bryant and Piepenstock , 2008). Statistical Manual of Mental Disorders (DSM) recognizing ”Feeding and Eating Disorders” as an overarching category. It includes pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, and unspecified feeding or eating disorder (Bryant, 2013). Pica is an eating disorder defined as the persistent eating of nonnutritive substances (e.g., plaster, charcoal, clay, wool, ashes, paint, and earth). The eating behaviour is inappropriate to the developmental level (e.g., the normal mouthing and tasting of objects in infants and toddlers) and not part of a culturally sanctioned practice (Emily and David, 2011). The term pica comes from the Latin word meaning magpie, presumably named after this bird’s peculiar eating behaviours. The magpie is a bird that is reputed for its unusual eating behaviours where they are known to eat almost anything (Thyer and Wodarski 2007). The eating patterns are referred to as ”-phagias,” such as pagophagia for ice eaters, geophagia for clay eaters, trichophagia for hair eaters , coprophagia for faeces eaters and amylophagia for starch Summary 86 eaters(Edward et al., 2000). Studies have shown the antiquity and worldwide distribution of geophagia .There are indications that the phenomenon is not restricted to any particular age group, race, sex, geographic region, or time period (Bisi et al., 2010). Numerous aetiologies have been proposed but not proved, ranging from psychosocial causes to physical ones. They include nutritional deficiencies (e.g., iron, zinc, and calcium), low socioeconomic factors (e.g., lead paint), child abuse and neglect, family disorganisation (e.g., poor supervision), psychopathology, learned behaviour, underlying (but undetermined) biochemical disorder, and cultural and familial factors (Emily and David, 2011). Discovery of pica behaviour in a particular patient can be difficult; diagnosis depends on self-reporting. Eating non edible substances repeatedly after 18 months of age is usually considered abnormal. The onset of pica usually between age 12 and 24 months, and the incidence declines with age (Kaplan and Sadock, 2009). Geophagia and other forms of pica are associated with a high rate of complications and substantial morbidity and mortality (Alexader and Akos, 2002). Complications of geophagia are closely linked to amount of ingested material. They include parasitic infestation, electrolyte disturbances and intestinal obstruction. Perforation and peritonitis are rare but the associated mortality is very high (Alexader and Akos, 2002). Although pica in children often remits spontaneously, a Summary 87 multidisciplinary approach involving psychologists, social workers, and physicians is recommended for effective treatment (Williams and Adam, 2012). The prognosis for pica is usually good because in children of normal intelligence generally remits spontaneously within several months. In childhood, pica usually resolves with increasing age (Kaplan and Sadock, 2009). Our study was conducted on two thousands and four hundreds children visited a pediatric outpatient clinic of Menoufiya university hospital from November 2012 to April 2014. One hundred and seventy four patients of them suffering from pica were participated in the present study. These patients were divided into two groups, group (I) of direct pica whom patient, s mothers gave direct history of abnormal feeding behaviour (pica) and group (II) of indirect pica whom patient’s mothers gave indirect history of pica that their main complaint was abdominal pain, vomiting, diarrhea, sore throat and etc in presence of abnormal feeding behaviour. All patients were subjected to the following: 1.Full history taking 2. Thorough clinical examination 3. The following investigations were done Ø Routine investigations: Ø Specific investigations: serum iron - serum ferritin –serum zinc Summary 88 Results were collected , statistically analyzed : from two thousands and four hundreds children visited pediatric clinic, of them one hundred and seventy four patients of them were suffering from pica (prevalence of pica was 7.2%). Their age ranged from (20-72months), with mean age (39.33 ±12.07) months and median age 37months.Majority of children suffering from pica in our study were 4 years or less withdefinite male predominance. Prevalence of pica was higher in: • Bottle-feed children than breast-feed. • Poor nourished children than good nourished children. • Children living in rural areas rather than children living in urban area. • Children of mothers had education status up to higher secondary as compared to illiterate and academic mothers. • Children of housewives mothers as compared to working mothers. • Children of low socioeconomic families (40.2%) than others. About 23.6 % mothers gave direct history of pica. The main presenting complains were diarrhea followed by cough followed by abdominal pain followed by itching anus followed by poor appetite followed by sore throat and vomiting. Clay was the main material used by children (major form of pica in this study) followed by Dust followed by paper and cigarette and least percentage was for stool, ice and hair. Summary 89 The majority of children had haemoglobin, serum iron, ferritin and zinc below reference values. Hemoglobin level is significant low in clay than dust, paper and cigarette eaters. Majority of cases have parasitic infections of which Ascaris is the most common form of infection. |