Pica and rumination disorder OSCE — harm gate, discriminator and behavioural plan

Station objectives

1. Run the harm gate before assigning a behavioural label — lead poisoning, bezoar, helminth infection, malnutrition and weight loss come first. ^{[2] [12]}
2. Distinguish pica from normal developmental mouthing and rumination from reflux, cyclic vomiting and purging using the effortless, post-prandial, non-nauseated quality. ^[9]
3. Treat reversible drivers — iron and zinc deficiency, the lead source, infection — and re-assess the behaviour as they resolve. ^[1]
4. Co-build a behavioural replacement plan — supervision, response prevention and enrichment for pica; diaphragmatic breathing and habit reversal for rumination — and refuse punitive restraint. ^[6]