Constantly chewing – could this be Pica?

Do you have a child who chews on their collars and sleeves all the time? Some people put this down to stress, anxiety, boredom or even a compulsion as part of an OCD picture – but it can also be a sign that they have nutrient deficiencies! My kids used to do this until I discovered that it was their way of telling me they needed more zinc and iron. They would stop chewing on their t-shirts within days of adding in more zinc and iron into their diet or top up with supplements and this saved their clothes from being ruined!

Some kids take the chewing thing further and they can’t get enough of sucking or chewing on non-food items such as toys, stones, sand, ice cubes, tissues or paper – constantly needing the sensory input of having something in their mouth – this again may be a sign that they have a much higher need for mighty minerals. Of course, babies naturally put everything in their mouth, but if this happens in children over the age of two, then it may be something called Pica.

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What is Pica?

Pica is a sign that the body is trying to correct a significant nutrient deficiency. These deficiencies are usually associated with low iron and/or zinc. As well as the mouthing of non-food objects, little signs you can look out for are pale lower eyelids (low iron) and white flecks on the nails (low zinc) – these are certainly not definitive ways to determine nutrient levels and are just pointers that a blood test or hair elements test would confirm. These kids often also have sore tummies, poor appetite and have pale skin, are tired and very fussy with their food.

Low iron tends to lead to poor appetite, a sore tummy and lethargy. Low zinc is often associated with very selective eating (kids who avoid most fruit and veg, and have a narrow selection of food choices) and disordered eating as it can affect the sense of smell and taste as well as the perception of texture in the mouth. Many kids with avoidant/restrictive food intake disorder known as ARFID are low in both zinc and iron.

Why is it a problem?

Putting non-food items such as soil or stones in the mouth poses a higher risk for acquiring a parasitic infection which can perpetuate things further. Clothes chewing and/or Pica may also get worse if a child has a parasitic infection as worms and amoebic parasites can deplete the host of a wide range of nutrients including zinc and iron. Remember to worm your dog too, as households with dogs have a higher risk of parasitic infection.

Another risk from Pica is the potential for lead toxicity which can reduce IQ and growth. Even though many policies have been put in place to reduce lead exposure, it is still present in a number of children’s toys and old household paint as well as in our soil. Interestingly lead toxicity can lead to anaemia and so lead exposure can get the ball rolling in the first place leading to the Pica and so it has the potential to perpetuate the problem. Also, optimal dietary zinc can reduce how quickly lead is absorbed and can reduce toxicity.

Finally, some kids successfully swallow the items they put in their mouth and this poses a risk of intestinal blockage or puncture the gut lining which can be make them very unwell and can even be fatal. This is why as parents we need to be very on the ball when our kids put things in their mouth.

It can happen in pregnancy too

Pica is common in pregnancy too, and pregnant women who are low in iron or zinc can start to crave all sorts of things from ice to coal. This is because risk of anaemia and low iron is very common in pregnancy. Nutrients can also get easily depleted if morning sickness leads to vomiting, and especially so in those women suffering from extreme morning sickness called Hyperemesis gravidarum. It is important to correct these during pregnancy as iron and zinc are important for both the baby’s development and for the mother’s recovery from the birth and reduces risk of post-natal depression.

Why do we get zinc & iron deficiencies?

Firstly, many kids (and some adults too) don’t eat enough zinc and iron-rich foods – think eggs, salmon, prawns, milk, chickpeas, pumpkin seeds and dates for zinc; and liver, red meat, eggs, spinach, lentils, sesame seeds, apricots and molasses for iron. Vegetarians and vegans are more likely to develop iron and zinc deficiencies as it is harder to get enough of these in a plant-based diet and so it’s important to learn how to optimise the iron and zinc when eating plant-based.

Children need A LOT more zinc when they are going through a growth spurt and during puberty – it’s sometimes very tricky to keep up even with the best diet! Also some kids have problems digesting and absorbing the nutrients from the food they eat, and this is where stool testing and screening for malabsorption can be extremely helpful. There are also genetic SNPs and other metabolic issues which can predispose kids to low zinc and iron levels and again these are things that we can investigate for you.

Another theory of why PICA and other eating disorders centred around distorted oral sensitivity happen, is the presence of chronic low-grade arsenic toxicity. A build-up of arsenic can affect gastric health (leading to poor secretion of gastric juices which are meant to rev up one’s appetite). Arsenic can also affect the neurological system which can lead to olfactory dysfunction, due to its effect on the sense of smell, taste as well as texture perception. This can lead to food refusal with chewing or mouthing of non-food items. Rice that has not been soaked and washed properly as well as gluten-free foods, rice cakes and rice milk pose a risk for high arsenic exposure. Equally, eating too much non-organic poultry (such as chicken nuggets) and non-organic fruit/fruit juice can mean that excess arsenic builds up in the system. Both arsenic and lead toxicity can be identified through hair mineral analysis.

What can you do to help?

Find recipes packed with zinc and iron-rich foods and feed your children these at least twice a day. To fast-track things add in iron (7-11mg daily) and zinc (3-11mg daily – 15mg for age 12+) food supplements. If they have a marked deficiency they will need more, but that would need to be guided by your NatureDoc or GP.

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