The public health unit was notified about the patient’s elevated serum lead levels, and a public health unit team member had contacted the family before his follow-up appointment however, a source for the lead was unclear. Other blood tests were unremarkable, including FBE and iron studies. The results showed an elevated lead level of 9.4 µg/dL (0.45 µmol/L), with the normal range <5 µg/dL (0.24 µmol/L). However, they eventually arranged for his blood tests to be completed nearly three weeks before his follow-up appointment in the paediatric clinic. His parents were reluctant to have the blood tests completed after his initial paediatric appointment. His attention and hyperactivity remained, and he continued to eat non-food objects. His speech had improved he was able to construct short sentences with poor pronunciation. The prevalence is unknown however, it is suspected that pica occurs more frequently in patients with developmental, behavioural or intellectual disabilities. Pica most often occurs during childhood however, it can occur at any age. Where the eating behaviour occurs in conjunction with another medical condition including pregnancy or mental disorder, it warrants further investigation. Answer 3Ī formal diagnosis of pica requires all Diagnostic and statistical manual for mental disorders, 5th edition, criteria to be met the patient would be eating non-nutritive substances over the period of at least one month, and this is determined to be inappropriate for the current developmental stage of the patient and not culturally supported. 2,3 Results showing iron deficiency anaemia 1 or otherwise unexplained lead toxicity may point towards a diagnosis of pica therefore, a thorough pica history and a high index of suspicion can help clinicians formulate a diagnosis. Pica in paediatric patients presents with non-specific generalised symptoms including chronic abdominal pain, headache, change in appetite and behavioural issues. There is a strong association with an iron deficiency, which is believed to drive the abnormal consumption. Pica is a medical and psychological condition in which an appetite for non-food, non-nutritive substances arises. What is the epidemiology of pica, and where is it most commonly seen? Answer 1 What are the diagnostic criteria for pica? Question 4 How might a patient with pica present? Question 3 Blood tests including full blood examination (FBE), iron studies and serum lead levels were also recommended. Behaviour modification strategies and speech and occupational therapy were recommended by the consulting paediatrician. He was known to bite other children during playtime when overly excited. He presented with hyperactivity inattention developmental delay including receptive and expressive language delay, motor delay, cognitive delay, delayed social skills and sensory-seeking behaviour and, most notably, the mouthing of non-food objects including toilet paper, tyres of toy cars, pencils and pens. A boy aged 3.5 years presented to the paediatric clinic of a metropolitan teaching hospital with a 14-month history of pica and behavioural problems.
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