Pica and rumination disorder — formative SAQs

SAQ 1 (10)

A 3-year-old living in housing built before 1970 is brought because of persistent paint-chip eating over four months. The child is irritable and has mild developmental regression. ^{[2] [12]}

1. Define pica and state why this presentation triggers the harm gate before a behavioural label is assigned. (3) ^{[1] [2]}
2. List five must-screen complications or drivers for this child. (3) ^{[2] [12]}
3. Outline your targeted investigations and first-step management principles (no invented drug doses). (4) ^{[2] [12]}

Model answer

Definition and harm gate. Pica is persistent eating of non-nutritive, non-food substances for at least one month that is not developmentally or culturally appropriate and is not better explained by another disorder. Irritability and developmental regression in a paint-chip eater trigger the harm gate because they suggest lead toxicity; the complication is assessed and treated before a behavioural label is fixed. ^{[1] [2]}

Must-screen items. Lead poisoning; iron or zinc deficiency; bezoar or obstruction; helminth infection (Toxocara or Baylisascaris with soil/geophagy); malnutrition or growth faltering; dental sequelae. (Any five.) ^{[2] [12]}

Investigations and management. Blood lead level, full blood count, iron studies, zinc level, electrolytes; growth and developmental assessment; abdominal imaging only if obstruction is suspected; dental review. First-step management: remove the lead source and involve public health; correct deficiency; begin behavioural intervention with supervision, response prevention, redirection and positive reinforcement; set review and explicit safety-net return criteria; escalate for encephalopathy or rising lead. ^{[2] [12]}