May Institute: Behavioral interventions can help parents address pica - mouthing of small objects - by children

The Republican Newsroom By The Republican Newsroom The Republican
on August 03, 2011 at 2:02 AM

Pica is defined as the ingestion of nonnutritive substances such as dirt, paint, or clay. Research indicates that 25 percent of children with autism and other developmental disabilities may have pica.

In addition, a larger percentage of children with autism may “mouth” objects, or put small objects into their mouths.

It is common for all children younger than 2 years of age to put non-food items in their mouths when they are teething or as a way to explore objects. This behavior is a normal part of healthy development, and may explain why some children with developmental delays continue to mouth objects.


If a child continues to eat non-food items after age 2 despite consistent efforts to stop the behavior, parents should consult with a behavior analyst or medical professional. Even if a disabled child is developmentally younger than 2, it is important to intervene with pica because it is a potentially health-threatening behavior that may worsen over time.

Individuals with pica may be at risk for serious health problems including:

bowel problems (from consuming indigestible substances like hair);

dental injury (from eating hard items like buttons);

intestinal obstruction or perforation (from eating objects that could get lodged in the intestines); and

parasitic infections (from eating dirt or feces).

There are several ways parents can help reduce pica and inappropriate mouthing behaviors. Many children may respond well to simple redirection.

For example, a parent might quickly remove non-food items from a child’s hand if the child brings them within one inch of his mouth. In addition, parents can have food items readily available in many locations so the child could be directed to eat something nutritious instead of engaging in pica. If parents are concerned about calorie consumption, celery and carrot sticks may be good, crunchy choices for redirection.

If simple redirection is not effective, parents may want to seek the help of a behavior analyst and implement a “differential reinforcement” or another behavioral procedure.

Differential reinforcement involves rewarding the child every few minutes if he refrains from engaging in pica. The time interval between rewards depends on the frequency of the behavior – the time between rewards needs to be shorter than the time between pica incidents.

For example, if a child usually engages in pica five times an hour, or every 12 minutes, parents might praise him and provide a reward every time he refrains from pica behaviors for 10 minutes.

At the May Center for Child Development, some children have benefited from a “temptation training” protocol. During temptation training, a child is given both food and non-food items and rewarded every time he eats a food item. If he places a non-food item near his mouth, it is taken away. Eventually, the child is monitored surreptitiously, so the parent or teacher can see whether or not the child will eat a non-food item if he does not know he is being watched.

If the child refrains from eating non-food items for a specific time interval, he is rewarded appropriately. But if he begins to eat a non-food item, the parent or teacher intervenes immediately, redirects the behavior, and shows the child that he has not earned the reward.

Pica can be both very dangerous and stigmatizing for children with developmental disabilities. Therefore, parents whose children display symptoms of this disorder should seek guidance from medical professionals or behavior analysts. Although reducing pica behaviors requires consistent behavioral intervention, many children can learn to abandon this unhealthy habit.

Shannon Kay is director of the May Center for Child Development. She can be contacted in West Springfield at (413) 785-5462 or by email to
