الفهرس 
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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
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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
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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
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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.
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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.