There are no definitive laboratory tests to provide a diagnosis of pica. Instead pica is a clinical diagnosis, confirmed by the patient’s history.11 Suspicions about the presence of pica behavior should be investigated. Health care providers should ask the patient (or parent or caregiver, as appropriate) about pica behavior or unusual cravings, especially in high risk groups. Some patients may self-report the pica behavior. However, patients are likely to underreport because of embarrassment or because they are not aware the behavior could be problematic.13 An evaluation of symptoms may be the best approach. If a patient has anemia, lead poisoning or intestinal obstruction, the health care provider should investigate pica as a cause. Certain laboratory tests can be performed to confirm the symptoms, but the cause of the pica behavior must be admitted by the patient. Parents may be counseled to observe children for signs of pica behavior.