To help raise awareness of the issue, we are repeating the article published in the August 2018 e-bulletin regarding PICA

In October 2017, the SAR sub-group considered a case for a potential Safeguarding Adults Review regarding a gentleman who had died as a result of eating vegetation – a symptom of a rare condition known as pica. Although the case did not meet the criteria for a SAR, Nottinghamshire Safeguarding Adults Board would like to share some information around this condition, its causes, and what you may be able to do if an adult whom you support experiences this condition.

Pica (Eating Inedible Objects) refers to eating objects which are not suitable to be eaten, such as stones, faeces, cigarette butts, leaves, and clothing. Depending on the objects taken, pica can be very dangerous. If you are worried about a person who has eaten something which could be harmful, seek medical advice from a GP or hospital.  

What causes pica?

The exact causes of this condition are unknown. Pica can be linked to mineral deficiencies but the condition is often due to learned behaviours. These include:

  • Social attention
  • Getting a favourite activity
  • Escaping from a situation
  • Sensory feedback

A functional assessment can help identify why an adult or child is eating inedible objects or drinking excessively.

How can pica be reduced or eliminated?

Once the cause(s) has been identified, the Challenging Behaviour Foundation suggests that the following approaches can be tried:

  • Social attention: ignore the behaviour (when safe) or prevent the adult or child from eating the object with the least possible attention. It is vital to provide lots of positive attention when the person is not eating inedible objects. In the longer term, teach a safe way of asking for attention (e.g., sign for help).
  • Obtaining a favourite activity: ensure the adult or child can access their favourite activity/object without eating a harmful item. In the longer term, teach a safe way of asking for their favourite activity (e.g., sign for biscuit).
  • Escaping from a situation: look for behaviours that tend to occur before the adult or child eats something inedible. These can tell you that the person wants to end an activity or escape. Think about whether the activity is too long, too difficult, or something the person doesn’t like.
  • Sensory feedback(e.g., taste): provide the adult or child with items that safely offer the same experience. For example, if a person eats cigarette butts due to the strong taste, provide strong tasting foods (e.g., marmite).

What can you do if you have concerns that someone you support is experiencing pica?

  • Support them to request a general health check from their GP to rule out medical problems as the cause.
  • Support them to request a blood test from their GP to rule out iron and zinc deficiencies as the cause
  • Support them to request a mental health assessment to rule out mental health problems as the cause.
  • Support them to ask their GP or social worker for a referral to a clinical psychologist or behavioural specialist for an assessment.

For more information on pica, please see this information sheet:



10 May 2019:12:49