1. health and fitness
2. disorders

Treatment
of Pica
with
Mineral
F.
IARGARET
GUTELIUS,
M.D.,*
J.
GEORGE
I
the
N
long
history
recurring
relationship
In
1
order
of pica
1895.
in
association
the
type
eating
with
pica,
which
dirt,
slaves
rarely
reported
other
hand,
of
recent
years
associating
The
by
from
in
this
brief
one
type
not
In
Gutelius
and
It
On
of pica
and
Ford,6
interviews
based
third
of
in
1942
geophagy
acid
were
children
with
pica
children.
trol
that
the
children
iron
was
more
the
with
of
the
*
the
Research
District
of
Assistant
Foundation,
Columbia,
Clinical
Washington
tion.
University
Columbia;
Children’s
of
address:
Psychology,
Iowa;
I)istrict
George
Washington,
Iowa
of
and
District
Professor,
;
in
School
1Medical
Social
of
of
of
investigation
was
supported
by
a Public
Anzerican
Journal
of Clinical
Nutrition
found
that
blood
levels
lower
in
the
of
thirty
control
Health
Division
388
pica
supplement
and
protein
was
considered
had
effect.
have
child
However,
been
desirable
diets
to
fit
obviously
addition
of cal-
children
previous
the
Vol.
a
nutri-
a practical
since
that
with
tailored
of these
unnecessary
demonstrated
pica
were
the
the
curative
from
procedures
that
in
prove
or a complete
the
and
lacking
diet
to
rela-
Despite
of
such
soluthe
treatment
Furthermore,
ones
saline
remains
thus
each
of
the
anemia
nutrients
would
for
of view,
and
and
needs.
not
than
that
possibility
adequate
specific
of
deficiency
or
cause
did
pica
suggested
the
it
studies
authors
in curing
nutrient
impossible.
Maryland.
This
niacin.
administration
of cause
the
point
Bethesda,
one
investigate
his
these
iron
findings,
other
tive
the
Medicine,
Service
research
gramit (RG-5923R1)
from the
of Research
Grants,
U. S. Public Health
Service.
not
completely
Pediatrics,
Worker,
low
and
in a comparable
effective
Theoretically
to
Pleasant,
Hospital
Associate
University
C.
Columbia,
Mount
and
evidence
diet might
in treatment.
of
Department
Children’s
and
\Vashing-
of
was
some
Children’s
HosChief Psychologist,
College,
Staff,
Columbia,
D.
the
others9
significantly
between
these
George
Department
thiamine
than
higher
particularly
administration
Their
pica
C.
Medicine,
Associate,
Wesleyan
Washington
of
Foundation,
Head
§ Associate
D.
of Pediatrics,
School
Hospital
Hospital
Washington,
Professor
ton,
D. C. ; f Research
Psychiatry
and Research
pital of the District
of
present
Children’s
were
intramuscular
intramuscular
diets
tionship
From
Institute
of a significantly
However,
find
indicated
former
subjects,
Tuskegee
concentrations
obtained
grade
Mississippi,
association
until
malnutrition.
on data
diets
the
control
of eighty-six
control
at
the
ascorbic
was sigAfrican
group.
In
addition,
they
found
that
the
amount
of milk, meat and foods rich in vitamin
C contained
in the diet
of the children
with
pica was less satisfactory
than
that of the con-
evidence
presented
with
in
much
with
the
pregnant
Moreover,
1962
hemoglobin
is
finding,
and
been
evidence
county
possible
iron,
race.5
has
suggestive
Dickens
calcium,
among
otherst
that
diets
twenty
in calories,
century.3
and
and
of
children
Negro
there
pica
percentage
‘
the
women
with
the
reported
problem
Lanzkowsky
in comparable
This
serious
young
than
analyzing
diets
nineteenth
among
pica
In
inadequate
the
recently
with
Edwards
involves
PH.D.4
children
is found
in this country
today.4
‘benign’
pica is a common
‘
especially
a
More
pica
primarily
the
in iron.
LAYMAN,
II
BA.
that
iron
deficiency
anemia
more
severe
in twelve
South
women
in
M.
EMMA
DUBLIN,
showed
nificantly
children.
two
die of malnutrition.
was
in
it
of
M.D.,t
C.
deficient
of
by Thomson
extremely
often
of
male
MILLICAN,
CHRISTINA
problem
existence
or cachectic
victims
of
this
the
differentiated
“Malignant”
and
M.D.
a question
understand
recognize
first
K.
AND
FRANCES
has been the nature
of the
this habit
and malnutri-
to
to
Supplement
COHEN,
pica,
and
fat
12,
May
pads,
1963
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
is important
types
of
interest
between
a Vitamin
Pica
muscle
mass
pica
were
of
the
and
eighty
weight
children
that
in
cent
children
of
drinking
protein
intake
The
present
controlled
to test
pie vitamin
treatment
tageous
the
which
in the
major-
the
as
many
as
of the
value
without
of this
evaluated
.
iron
nutrient
and
the
D. C. during
196 1 .
The
cepted
for
Negro
children
(two
chronic
illness
(including
study
velopment
represented
four
whose
METHODS
AND
method
method
and
Roe
psychiatrist
poisoning)
using
the
the
the
or
and
the
M.)
pica
was
during
a
taken
and
of unsuitable
sucked,
of
More
ingestion
presence
chewed
of
such
pica
and
as
in
particles
other
rating
was
devised
for
18 ITh)miths
than
once
than
Frequency
a week
once
a
week
not
but
daily
2
One
3
Frequently
to
4
stantly
Practically
0
Not
three
times
a day
each
day
but
1
Ingests
nonedibie
substances
vorites
are available
2
Seeks
3
stances
Unselective
stances
all
the
not
con-
timiie
out
certain
in eating
0
Stops
when
1
Stops
when
nonedible
foods
nonedible
other
materials
to
Resistance
told,
food
to Control
does
not
reproved,
resume
resumes
when
reproved
in a few minutes
Stops
when
reproved
immediately
Does not stop
4
sub-
unavailable
in
situation
Stops
3
sub-
are preferred
when
Prefers
if fa-
nonedible
which
4
2
Intensity
present
but
resumes
but
resumes
Scores
C.
Duration
Frequency
Intensity
D.
Resistance
___________
factors
intensity
to
thirty
investigain workwas obof sucking,
materials
ingested
the
; the
stools;
of the
a scale
of
each
child.
Four
0 to
possible
was
usually
scored
between
constant
over
mained
was
demonstrated
pica
was
rated
in
worker
at
several
weeks
later
The
medical
on
each
complete
for
ova
The
maximal
of weeks,
series
ten
the
cases,
time
by the
first
of
a fact
in
by
screening
pica
rewhich
which
the
the
medical
and
again
psychiatrist.9
worker
Further
and physical
urinalysis
blood.
total
those
with
severe
10 to 14.
The
scores
another
social
occult
i).
frequency,
each rated
a period
family.
history
standard
and
16 ;
in
social
data
history-duration,
to control-were
4 (Table
rating
; possible
in the
members
from the pica
and resistance
pometry,
pica
of age)
of
family.
A
1
,,zonths
months
than
Total
for
by
twenty
with
pica.
Information
the onset and duration
the
Less
cyan-
obtained
patients
concerning
ingestion
Rating
nionths
de-
level
titration
interview
with the mother.
This
seven
years
of previous
experience
substances
proof
and
K.
of
18
Pica
Coleman-Junior
fasting
plasma
colorimetric
Kuether,’#{176} were
history
(F.
chewing
0
on
detailed
tamed
More
PROCEDURE
with
and
of
child.
with
4
without
growth
concentration,
using
minute
tor had
7-12
13-18
A.
B.
normal.
spectrophotometer,
ascorbic
acid,
A
2
3
D.
series
old)
lead
(after
Obtain
to
3 months
of Washington,
years
chronic
been
methemoglobin
ing
the research
of Children’s
a consecutive
to
hemoglobin
each
to
from
May
1960 to March
screened
by the
medical
deficiency,
had
of
been
(C. C. D.) during
a preliminary
intermother.
The twenty-four
patients
ac-
mental
The
already
clinics
period
were
Duration
.
Less than
3-6 months
C.
therapeutic
had
Order
as
MATERIAL
well-baby
the
cases
view
obvious
the
in pica
worker
with the
social
contained
elements
with
pica were
referred
the Outpatient
Department
Hospital
available
which
trace
since
4
0
1
.
CLINICAL
Children
team from
one
and
I
in
B.
multi-
in the
advan-
readily
as
Pica
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
but
well
vitamins
Scoring
undertaken
of a standard
a preparation
market,
possible,
was
of
C.,
fact
and
mineral
preparation
of pica.
It was considered
to study
on
study
efficacy
389
at
of cases.
in order
Supplement
TABLE
adequate
a
Mineral
1’detliocl
records
D.
milk,
and
with
the
nutritionally
were
of
sufficient
Vitamin
Washington,
amounts
indicated
of
studied
83 per
excessive
with
A review
Hospital
showed
ity
body
adequate.9
Children’s
or
Treated
secured
work-up
socioeconomic
included
examination,
anthroand stool examination
a
Gutelius
39()
General
et
TABLE II
on Twenty-Four
Information
Case
ernoglobmn
(gm./100
ml.)
(mo.)
and
Sex
Children
with
Pica
Pica
i-I
Age
al.
Ascorbic
Blood
Acid
Level
(mg./l
Substances
Duration
ml.)
(mo.)
I
27,F
10. 7
0.55
2
3
30,M
42,F
12 . 6
10 . 4
4
5
36,M
39,M
6
31,F
7
31,M
11 .6
11 .9
9 .9
9.9
0 . 75
0 . 50
1 . 05
0 . 48
S
23,F
7.9
(per
wk.)
18
20
3-6
1-2
35
26
1-2
35 +
Dirt,
starch
Crayons,
ashes
Plaster,
Paster,
Constant
0.50
27
22
22
35+
35+
Plaster,
Paper,
Paper,
0.92
15
7-21
Plaster,
.
.
.
Ingested
Frequency
dirt
paper,
dirt
dirt,
starch
dirt,
ashes
matches,
paper,
cigarettes
dirt,
starch,
matches,
ashes
9
1 1 .3
24,F
23,M
31,M
10.4
12 . 3
18
0.83
0 . 60
Plaster,
35 +
10
13
paint,
35+
3-6
Paper,
dirt,
rettes,
Plaster,
40,F
37,M
8.8
14
15
17
27,F
33,M
29,F
46,F
12.0
12 .3
9.9
10. 1
0.31
0. 15
0.40
39
35+
18
36,F
8. 1
1 .36
29
Constant
Plaster,
dirt,
19
2(1
27,M
25,F
7.0
11 .3
1 .05
1 . 60
16
19
7-21
21 +
Plaster,
Paper,
paper,
erasers
21
24,F
9.9
1 .00
16
35
Plaster,
16
24,M
22
3
1 . 00
3 1
0.90
25
35+
Paper,
crayons,
15
26
22
7-21
7-21
Constant
Paint,
Plaster,
Plaster,
Plaster,
paper,
paper,
paper,
paper,
.
10.9
.
.
.
.
Constant
15
.
crayons,
chalk,
string
stones,
string
dirt
starch
dirt,
starch
ashes
dirt
paper,
dirt,
starch,
matches,
cigarettes
Plaster,
paper,
paint,
35+
ciga-
pencils,
sticks
paint,
dirt,
“anything”
13
.
cigarettes,
soap
matches,
12
12
paper,
stones,
sticks
Dirt,
matches,
chalk,
dirt,
matches,
cigarettes
23
24
27,M
10.9
0. 77
15
27,M
10.0
0.40
15
Meami
30.8
10.52
The
multiple
vitamin
chosen
for the
This foil-wrapped
sidered
and
handle.
tamed
all
the
usual
A, 5,00()
units;
B,,
B6,
1 (1 mg.
thenol,
0.1
5.0
mg.;
2.5
;
and
the
vitamin
mg. ;
75
rug. ; vitamin
vitamin
I3,
125.0
; fluorine,
0.1
Mg.;
mg.
=
20.0
rutin,
0.1
mg.
0.2
; iodine,
1.0
mg. ;
con-
groups
group
U.S.P.
one
2
acid,
calcium
Supplied
by
White
Laboratories,
Inc.
2. 5 ing.
unusually
out
a table
received
each
by
the
The
high.
code
order
preparations
0.1
assigned
to
1.0
visited
the
the number
left
were
random
were
taken,
area
the
of
in
seven
more
two
The
first
group
were
for
the mother
the
a slip
nurse
Washington
which
for
into
known
to one investigator
on the regularity
with
home
once a week.
of chocolate
pieces
she gave
used
preparation,
second
Preparations
Association
the
were
vitamin
con-
identi-
divided
The
daily.
C
numbers.
and
a meal.
number
to check
vitamin
Placebos,*
in taste,
mineral
with
placebo
Nurse
week
of
the
day
one
In
and
*
was
Visiting
; magnesium,
molybdenum,
l)Otassitim,
using
ceived
lU.;
mg. ; vitamin
3.0 g. ; panmg.;
paper
paper
cal in appearance
and similar
the control
children.
The twenty-four
patients
: vita-
mg. ; cobalt,
mg.
in
and
(75 mg.)
1,000
mg. ; folic
12.0
to
used
E,
B2, 2.5
easy
;
tent
of iron
vitamin
tug. ; boron,
:3.0 Ing. ; manganese,
D,
activity
ing. ; nicotinamnide,
30.0
minerals
exception
units;
C,
biotin,
carbonate,
tug.
with
U.S.P.
vitamin
vitamin
preparation
to children
and
study
Delectavites
vitamins
PreParatiOns
mm
mineral
Plaster,
Plaster,
21.2
treatment
of pica was Delectavites#{174}*
preparation
of chocolate
was con-
generally
acceptable
At the
time
of
such
0.738
21 +
21+
the
following
of paper
only.
which
from
the
who
was
patient
She made
remaining,
regiven
lived
a note of
if any,
week.
on which
Each
she
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
10
11
0 . 38
Pica
was
the
to
check
the
days
preparation.
The
available
significant
rise
(Cases
7 and
of
in
plasma
levels
not
The
patient
the
like
time
levels
the
three
patients
took
the
These
children
prescribed
7 and
but
were
the
ascorbic
for
to thirteen
levels
of
months
status
of
ascorbic
after
pica
acid
the
was
determined
blood
not
I)ifferences
at
the
are
pr
)
the
deter-
(1.05).
In
test
was
testing
used
for
difTerence
sltmare
the
also
statistically
for
Yates
significant
confidence
or
better
(P
the two-tailed
and scores.
number
checked
vith
test
of
for significance
measurements
l)etween
was
series
as
level
of
cures
for
1.05
5
0.48
l)atiellts
hemoglobin
in
the
order
of
acid,
pica per
gested.
week
There
were
the
9
8
0.00
1.00
8
10
chi-
1.0.)
10
12
Mean
0.701
Patient
*
ple
9.1
unable
of
and
III.
hemoglobin
level
was
range
7.0
from
of
months
one
paper
The
the
pica
ratings
both
seven
weeks
later,
for
the
twelve
0.738
mg.
to
an
than
children
1.60
a
year
levels
treatment
at
end
who
a
received
of
was
found
0
0
±
1.5(1
9
2+
improve(I
1.02
7
2+
1.45
170
2 . 30
1 . 80
0
0
2+
0
9
8
±
improved
±
improved
1.549
5.2
history
pica
obtained
from
The
there
all
but
ascorbic
initially
and
treatment,
multi-
six
ml.
given
is
for the
pica
rating
is
also
twelve
given
and
in
(P
decreased
were
about
the
in
rise
<
1)001).
from
9. 1 to
as
being
iml)roved
and
same.
children
rise
mg.
This
reported
nsarkedly
in the
was
I .549
of treatment.
significant
three
no
initially,
end
highly
twelve
was
who
the
served
mean
as controls
blood
level
acid, which
was 0.779
mg. per
and (1.744 mg. per 100 ml. at
improved
and
five
remained
oi
10(1 nil.
the
of the treatment
period.
The mean
pica
decreased
from
10.2 to 4.4.
Six children
reported
as being
without
pica, one was
edly
and
pica
placebos
children
In the
21.2
acid
are
on
information
to be
pica,
of
by
lOt)
at the
remained
100
and
the
7
0
7
check
received
per
without
five
frequency.
before
the
mg.
matches
of ascorbic
1(h) ml.
Four
followed
starch,
mg.
per
mean
ingested
popular,
0.701
5.2.
per
in
relapse
mean
blood
level of ascorbic
acid
children
who
received
treatment
The
plasma
substances
relapse
(mild)
1+
preparation
final
same
who
with
with
average
of decreasing
to
ml.
was
most
blood
10()
mean
laundry
in order
fasting
per
0
after
Iv.
mean
girls
The
Of the
of
in-
The
gm.
for
more
10).
the
dirt,
cigarettes
for
frequency
twelve
(1.13
present
(Case
was
plaster,
from
been
and
case
10.52
acid
a range
had
and
months.
12.6
ascorbic
with
pica
to
boys
1+
0
1.00
1.50
1 . 80
but
mineral
A
The
The
twelve
sex,
level
substances
30.8
return
to
vitamin
Table
Table
age,
of pica,
1.80
ii
11
. . .
0.31
0.-to
in
blood
unsuitable
twelve
age
ml.
giving
10
13
each
the
twenty-four
fasting
duration
and
average
level
study
0
*
Pici
mother.
continuity.
of
1.17
of
to
Months
Treatment
Pica
Rating
5
0.92
0.38
patients
series
concentration,
of ascorbic
an
shows
Status
-
10
0.77
t
RESULTS
ii
Treatment
Ascorbic
Acid
(mg./I00
ml.)
9
recorded.
Table
Ratings
<
The
in
by
significance
correction
After
23
24
PROCEDURES
reported
cent
0.75
4
9
11
12
14
15
19
aimed.
STATISTICAL
2
8
but
were
Pica
(mild)
of treat-
investigated
the
in
of
re-evaluation,
period
amid
Acid
----.-
Pica
Rating
(mg./100
ml.)
adequate
At the end
so that
the
be
a final
III
Ascorbic
about
end
rating
were
markthe
same.
Thus,
there
were
at
were
apparently
the
seven
end
of
the
children
cured
treatment
in each
or
much
period,
group
improved
who
and
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
the
could
At
of
Treatment
Acid
a period
391
Ascorbic
Case
placebos.
daily
acid
re-evaluated.
Levels
Before
preparation
receiving
given
Blood
(Cases
took
were
Supplement
for Twelve
Childremi
with Pica Before
and After Six to
Seven Weeks
of Treatmuemit
with
Multiple
Vitamin
ami(l
Mineral
Preparation,
and
Final
Status
of Pica
C in the
vitamin
exceptions
; both
of
pica
ment,
Mineral
TABLE
two
candy
preparations
blood
and
took
with
six to seven
weeks,
which
was considered
to saturate
body stores with vitamin
C.”
of this timne the Patients
were seen again
and
Vitamin
a statistically
of
that,
regularly.
the
the
including
indicated
22),
preparations
most
which
evidence,
patients,
did
on
with
Fasting
treated
22)
Treated
392
Gutelius
TABLE
Fasting
Blood
Levels
iv
of Ascorbic
for Twelve
Children
with
Seven Weeks
of Placebos
Acid
Pica
Pica
Before
and
and
Daily,
and
Final
Given
Ratings
After
Six to
Treatment
Acid
(mg/lOt)
ml.)
:
io
Treatment
0.55
8
0.50
12
0.45
9
0.48
...
group.
1.00
0
± improved
2+
0
0.00
0.90
1.20
It;
0_is
13
0.51
3+
i7
18
0.40
11
0.4:3
1.36
10
0
1+
relapse
Lost
*
to
but
group,
significant.
Among
provement
ascorbic
in
acid
than
in
initially.
the
the
difference
treated
those
whose
were low initially
those
whose
blood
and
eleven
and
five
in
each
three
and
control
three
in
improvement.
control
after
apparent
are
summarized
Delectavites
placebos
pica.
in
children,
blood
was
not
im-
levels
of
no greater
were
high
the
large
treated
results
series
pica
there
children.
Four
of the forlatter
were without
pica,
were markedly
improved,
each
group
showed
treated
little
children
or
and
was
above
children
in distributrue for all
that
mineral
for
than
neither
The
though
pica,
cause
per
at the
remission.
10(1 ml.,
end
of
other
improving
the
habit
number
of cures
observed
and
control
children
can
none
;
of
of them
one
had
indicates
that
be associated
conditions
groups
TABLE
no
yet
study
socioeconomic
of Pica
Treatment
in five
Delectavites
a
even
with
important
dietary
for six or seven
weeks
offers
Both
pica and poor nutrition
from
lowest
than
these
prove
to be
given
alone.
Table
II shows
is not in itself
an
At least
a standard
given
cure.
result
in the
might
one
present
experiment
poor nutrition
may
it probably
of pica.
supplement
concentration
who received
12 gm.
was cured
temporary
Supplement
exist
Negro
V
with
and
which
of the
a Vitamnin
Summary
and
of
Mimieral
Results
one
relapses
two to six months
cures.
The results
of treatment
in Table
v.
It is clear
that
proved
no more
effective
than
or
con-
more
successfully
a possibility
that
had
curing
to such
it is not
of preschool
and
any
is
that
the hemoglobin
the twelve
children
may
. -
I ype
Preparation
of
No.
Patients
of
COMMENTS
The
a large
a vitamin
supplement
no specific
took
place
three
treatment
period,
treated
patients
the
group
of
Two
child
was
levels
The
final interview,
which
to thirteen
months
after
the
was
completed
for
twelve
mer
final
medications
given
together
more
effective
than
either
This
seems
most
improbable.
0.744
study.
treated
nor
can
cure
placebos,
2+
five who did not improve.
The
pica
ratings
suggested
that
the
improvement
in the untreated
group
was somewhat
greater
than
in
the
the
pica no difference
was found
by sex,9’2
and this fact holds
iron9
0
0
0.75
10.2
continued
given
improved
10
0.779
that
support
those of the other
sex.
Since
it has been demonstrated
0.30
Mean
shown
age groups.5
Thus,
there
is no tendency
children
of one sex to be cured
more easily
1+
1 .50
In
with
tion
improved
7
7
been
nondirective
.:.t
or
End
reatment
of
3-13
Months
Months
after
Treatment
%
No.
NoH
Medication
Placebo
in both
be ex-
of
Cured
*
One
12
12
lost
to
study.
7
7
58
58
Much
Improved
9
8
%
75
73*
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
13
10
i2
. - .
has
of spontaneous
with increasing
sidered
of any importance
that
eight
boys and
four girls were assigned
by chance
to the treated
0.50
0.83
0.90
1.60
1.00
also
and
of the pica.9
In evaluating
13
20
21
22
It
the
result
takes
place
families
are factors
in curing
children
with pica
even when
no advice
is given
on management
Ascorbic
Acid
(mg./100
ml.)
Pica
Rating
plained
partly
as
improvement
which
interest
After
Ascorbic
Case
al.
age.5
Status
of Pica
Before
et
Pica
race
in which
these
pica
is most
conditions
other
lack
home
is
may
the
acceptable
logic
problems
are
conimon
than
In
poor
present
with
the
ernment
one
living
pica
of
for
two
confined
children
other
twelve
turbed
parents,
family
mother
to cope
home.
Thus
support
to
pica
involves
tural
and
their
3.
Africana
or
the Negro
146, 1844-5.
4. GARDNER,
J.
genographic
in children.
5. MILLICAN,
F.
families
on public
TAKAHASHI,
working
lence
of
substances
or
clay
series
had
during
the
preg-
habit
was
families
of pica.
quarrels
or
her
with
of
numerous
environmental,
mm
and
of
75
etiology
of
six
to
twelve
seven
At
much
acid
not
pica
end
in
rose
three
treatment
each
group
Treatment
to
the
treatment
were
The
with
preparation
or improving
the
only
habit
no
seven
12.
13.
group
after
three
to have
7 : 59,
more
effective
of pica
than
but
on
the end
children
of
in
pica.
and
mm-
in curing
placebos.
Orleans
of dirt
eating
in
M.
S.
1:
&
J.,
TEVETOGLU,
and
mouthing
children.
Clin.
of
Proc.
nonedible
Child.
Ilosp.,
FORD,
N.
R.
school
Geophagy
children.
among
An,.
Sociol.
LANZKOWSKY,
acid
in whole
147:399,
blood
and
urine.
J.
Biol.
1943.
R. W. Ascorbic
acid.
In: The Vitamins,
1, sec. 10, chapt.
2, p. 378.
Edited
by Sebrell,
\v. H. and Harris,
R. S. New
York,
1954.
Academic
Press Inc.
COOPER,
M.
Pica, p. 62.
Springfield,
Ill., 1957.
Charles
C Thomas.
WILLIAMS,
H. , KAPLAN, E. , COUCHMAN,
C. E. and
SAYERS,
R. R.
Lead
poisoning
in
children.
VILTER,
14.
Health
Rep.,
R.
and
MELLIN5,
logical
check
frequent
vitamin
cacliexia
on
effects
F.
Time roentof geophagia
(dirt-eating)
J. Pediat.,
51 : 667, 1957.
K. , LAYMAN,
E. M. , LOURIE,
R. S.,
L. and DUBLIN,
C. C. Time preva-
D. and
DICKENS,
Pub.
or
of ascorbic
a final
months
a multiple
was
period
treated
At
reported
served
children.
vol.
of
who
level
in the
period,
group
symptom-free
plasma
group.
thirteen
were
a period
11.
daily.
group
control
which
for
pica,
placebos
significantly
the
the
eral
of
each
daily,
acid,
with
given
improved.
in
vita-
A comparable
children
were
the
children
of ascorbic
weeks.
Negro
as controls,
Negro
New
E. and
diagnosis
in
1962.
Chem.,
twelve
1957.
P. Investigation
into the aetiology
and treatment
of pica.
Arch.
Dis.
Childhood,
34: 140, 1959.
8. EDWARDS,
C. H., MCDONALD,
S. , MITCHELL,
J. T.,
JONES,
L. , KEMP,
A. M. , LAING,
D. and TRIGG,
L.
Clay
and
cornstarch-eating
women.
J.
Ant.
Dietet.
A., 35: 810, 1959.
9. GUTELIUS,
M. F. , MILLICAN,
F. K., LAYMAN,
E. M.,
COHEN,
G. J. and DUBLIN,
C. C. Nutritional
studies
of children
with
pica.
I’ediatrics,
29:
1012, 1962.
10. ROE, J. H. and KUETHER,
C. A. Determination
of
7.
cul-
a multiple
preparation
mg.
race.
by
ascorbic
given
Observations
and
1942.
adds
the
experiment
mineral
contained
-
3: 81, 1895.
M.
Rev.,
9
were
en
Ill.,
dirt-eating
or
hal)it
had
the
pica
the
Negro
in the
experiment
that
pica
with
problem.
Springfield,
\V.
Mississippi
disof the
inability
present
6.
5.
Rep.,
not
At least
responsibilities
hypothesis
a double-blind
psychologic
p.
ingestion
18:207,
SUMMARY
Iii
CARPENTER,
with
in the
On
Hosp.
three
psychologic
children
J.
THOMSON,
benefits,
a history
the
in accord
is a complicated
and
Pica,
more
16
were
obviously
seriously
problems
as separation
the
are
pica
C Thomas.
Edinburgh
included
Fourteen
with
2.
in gov-
six
M.
COOPER,
families
of them
with
families
by such
homes
The
pregnancy.
that
cultural
Charles
extremely
incomes
starch
in many
to
four
mothers
laundry
and
and
was
projects.
1.
groups.
housing
Seventeen
nancy,
pica
significantly
satisfactory
and
mothers.
with
be
exception
experiment
findings
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control
on disability
assistance
vironmental,
culturally
group.5
to
series
most
in
of this
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15.
16.
67:
B. and
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1952.
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psychological
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F. K., LouIE,
R. S. and LAYMAN,
E. M.
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and treatment
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R. S. , LAYMAN, E. M., MILLICAN,
F. K.,
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L.
A study
of
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of i)iCa in young children.
In : Problems
by
of
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R.
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& Stratton,
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J.
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p.
York,
74.
1958.
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
the
live
of pica.
often
population
housing
with
previous
dangers
is
in comparable
the
in
inadequate.
of the
thought
Results
of
Supplement
Super-
in children
families
Mineral
out
usually
frequently
habit
in this
and
Some
play
be ignorant
Furthermore,
Vitamin
pointed
children
which
at
Parents
been
These
areas
vision
with
prevalent.5
have
studies.9
slum
Treated