Treatment of pica should take multiple approaches as no one treatment is universally effective. The first concern would be the treatment of medical problems such as obstruction, infection or heavy metal poisoning.13,15 Nutritional counseling might be the first wave of intervention.13 Education about proper nutrition and elimination of consumption of nonfood items as well as iron or zinc supplementation may be effective. Patients can be encouraged to substitute better food choices for the craved substance: sugar-free candies for pebbles, powered milk for starch or sugar-free ice pops for ice or freezer frost. Psychological approaches could include counseling and behavior therapy. Interventions such as positive reinforcement for eating from a plate have been effective in children with developmental disabilities. Mild aversion therapy, where unpleasant consequences or punishment followed by positive reinforcement for eating the correct foods, has been successful.13 A combination of positive reinforcement and response reduction, blocking or obstructing the patient’s attempt to consume the pica substance, have shown good efficacy.11 The identification of stressors followed by stress reduction therapy is warranted, especially in children where family-based stress may play a role.13 In certain cases, pharmacological intervention may be necessary. Selective serotonin reuptake inhibitors, prescribed for patients with anxiety, depression or other mental disorders; atypical neuroleptics (olanzapine) and attention-deficit/hyperactivity disorder medications (methylphenidate) have been used, with varying levels of success.8,11,13,15 Not all pica substances are dangerous and intervention might not be necessary in some cases.13 For instance, if the pica substance being consumed is small quantities of cornstarch and no medical or dental issues are present, there may be no benefit to counselling the patient to stop consuming the cornstarch. The patient should be educated about consuming excessive amounts of cornstarch due to additional empty calories.
Pica can last for a number of years then resolve on its own; especially when the behavior is seen in childhood and the patient enters teen or adult age.13,15 Prevention strategies may be important as well. Pica is most often practiced when the patient is alone or unsupervised.8 Increased supervision, especially in children and patients with developmental disabilities, can prevent or lessen the behavior. Knowing about and getting proper nutrition may be helpful.15 Removing or reducing access to the source of the pica substance (removing lead-based paint chips or monitoring children playing in sand boxes) is important.13 Stool checks may be used with institutionalized patients.8