Pica and Rumination Disorder: diagnosis and treatment approaches

Pica and Rumination Disorder: diagnosis and treatment approaches

Abstract

Pica is derived from magpie, which is a Latin word for a species of a bird that consumes whatever it gets into its mouth. Pica is best defined as a condition of a person craving and consuming non-nutritive substances. It is not appropriate for proper development. It is an occurrence that is very common among the children below the age of 6 years. Naturally, small children can eat non- nutritive substances such as hair, paint, fabric parts, plaster and yarn while the older ones may eat paper, soil, erasers, stone and animal droppings. The appearance of pica condition can be as a result of physiological, biological as well as socio-cultural factors. Thus, in diagnosing pica, both anaemia and iron deficiency tests should be requested in all the cases. Some cases of pica occur as a result of abuse or negligence by the parents. Retardant development, schizophrenia and autism spectrum disorder ought to be considered in the differential diagnosis. (Van Osdol et al. 2017).  In behavioural approaches, techniques such as over-correction, positive reinforcements and role modelling should be applied. It is suggested in some studies that pica ought to be included in obsessive-compulsive disorder, and thus, in its treatment, the use of SSRI is effective..

Rumination can best be defined as the voluntary and repetitive ingestion of the food which has been swallowed. The food is either thrown out or swallowed once it is brought back into the mouth. It is a behaviour which cannot be explained by gastrointestinal disease, psychiatric or even medical conditions. It is often seen in kids between the age of 3-12 months, and in male infants, the frequency is higher. In Rumination Disorder development, the negative psychosocial environment plays a significant role. Regardless of adequate food intake, malnutrition may develop as a result of regurgitation. The medical complications are dehydration, dental caries, weight loss and esophagitis (Raha et al. 2017). The central nervous system lesions, gastrointestinal system infections and diseases which result in vomiting ought to be excluded.

Keywords: diagnosis; eating disorder; pica; rumination disorder; treatment.

Introduction

Pica is a disorder which comes about when children insistently consume one or more non-food items. Pica may not sound dangerous but considering the toxicity or the harm to the body resulting from the ingestion of these non-food substances makes the potential for illness as well as death clear. Serious medical problems, for instance, poisoning, parasitic infection, intestinal blockage and even death, occur as a result of pica. It is a disorder which has been described as one of the most severe forms of deliberate self-harm behaviour. This is because this behaviour has a high risk of death. The non-nutritive substances consumed by kids with pica vary with age, younger children frequently eat hair, cloth, plaster, string or hair; while older children tend to eat pebbles, sand, leaves, animal droppings or insects. Adolescents affected by pica habitually consume clay or other soil substances (Muething et al. 2019). The causes of pica put forward include family history of pica, anaemia, development delays, zinc deficiency and mental retardation. Other causes include lack of appropriate stimulation, lack of parental attention or oral fixations. Pica is more common children and adolescents having other developmental disabilities, for instance, mental retardation and autism.

Children having Rumination Disorder repetitively regurgitate and spit out or re-chew food after consumption. It is a disorder that develops in young children and lasts for at least a month before a diagnosis can be made. The symptoms usually start between the age of 3 to 12 months and then over and over again remit spontaneously after a period of time. Rumination Disorder is not shared and occurs more often in male children than the female ones (Murray et al. 2019).

Diagnosis

Diagnosis of pica

children suspected to have pica should be examined thoroughly by a paediatrician or a family physician because of the potential health hazards and risks associated with pica such as death, malnutrition and poisoning. During the assessment, the clinician must gather as much information as possible concerning the child. These include the child developmental, medical and psychological histories and also food-related behaviours, environmental factors which appear to activate symptoms of pica and the consequences of food-related behaviours (Muething et al. 2019).  A developmental assessment such as Bayley Scales and comprehensive evaluations of the child’s home environment such as dietary factors, levels of physical activities and practices of parental caregiving should be conducted.

Rumination disorder diagnosis

Children suspected to have Rumination Disorder should first be examined by a paediatrician to identify whether the regurgitation results from any natural source. Medical examinations can as well determine whether the children are suffering from nutrient deficiency, malnutrition or dehydration (Murray et al. 2019). Lastly, an environmental assessment is conducted to determine whether there is a link of the behaviour to family relationship problems, lack of stimulation and specific consequences like obtaining caregivers’ attention.

Treatment approaches

Pica treatment

Treating pica can be problematic. Encouraging children to consume a diet that is healthy and well balanced is one of the first steps. Replacing the non-nutritive substances which children ingest with more appropriate, nutritious foodstuffs is a crucial goal. It is essential to consult a dietician familiar with pica to make appropriate menu. Hazardous substances which are ingestible ought to be removed from home environments to ensure they do not tempt the children (Van Osdol et al. 2017). Stimulation is vital in decreasing pica. Therapists should assist both parents and caregivers in coming up with stimulation plans appropriate for development. For instance, stimulation in toddlers may involve playing a toy-searching game.

Treatment of Rumination Disorder

In the treatment of Rumination Disorder, a comprehensive behavioural modification plan that is based on learning principles is the focus. It is designed to discourage ruminative behaviour and encourage healthy eating behaviours. Caregivers and parents may be taught techniques of parenting that aim at providing increased interaction, stimulation and attention for children affected in support of the behaviour modification plan goals. There is also a need to consult with the nutritionists. In cases whereby children are in dangers that are threatening their lives as a result of the condition, they should be hospitalized till their situation stabilizes (Murray et al. 2019).

Conclusions

In the treatment of both pica and rumination disorder, increasing the amount of mother-child interactions as well as stimuli is likely to give positive results. Behavioural approaches can be utilized in the treatment of both pica and rumination syndrome. There is a need to continually apply behavioural modification plans that are designed to reduce and ultimately eliminate pica and Rumination Disorder across all the environments that are encountered by children. This is crucial in ensuring that there is an occurrence of best results. In pica treatment behavioural techniques such as positive reinforcements, role modelling, and over-correction are applied; while in treatment of Rumination Disorder, the behavioural approaches applied include habit reversal using relaxation and diaphragmatic breathing (Raha et al. 2017).

References

 Muething, C., Call, N. A., & Clark, S. (2019). An Evaluation of Differential Reinforcement in the Treatment of Pica. Developmental neurorehabilitation, 1-7.

Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: a critical review. The American journal of gastroenterology, 114(4), 562.

Raha, B., Sarma, S., Thilakan, P., & Punnoose, Z. M. (2017). Rumination disorder: An unexplained case of recurrent vomiting. Indian journal of psychological medicine, 39(3), 361.

Van Osdol, A. D., Kallies, K. J., Fredrickson, K. A., & Kothari, S. N. (2017). A Different Kind of Craving: Incidence and Treatment of Pica After Laparoscopic Roux-en-Y Gastric Bypass. World journal of surgery, 41(9), 2324-2328.