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Understanding and managing pica

Published on 12 October 2026

Author: Dr Elizabeth Shea

Dr Elizabeth Shea is a Consultant Clinical Psychologist who has worked with autistic and neurodivergent individuals with eating challenges for 25 years. She specialises in the understanding and management of Avoidant and Restrictive Food Intake Disorder (ARFID), Pica (eating of non-foods) and Rumination Disorder. Her work has featured several times on the BBC and ITV and is the subject of three books. Dr Shea has held several senior NHS positions and regularly works with statutory, voluntary and community sector enterprises including as Advisor to the National Autistic Society (NAS) on eating challenges.   

“Our family would take trips to the seaside. I used to go to the beach and eat the sand; no one really noticed as I did it in secret. I found pleasure and adventure when I’m eating things that aren’t food.”
Patrice, recalling her childhood

Patrice describes her childhood pica for sand, a behaviour which she enjoyed but she also hid from her family. Patrice and I met two years ago on a UK TV show talking about her pica, which as an adult, is mostly for mortar, or cement from a wall in her house. I really admire Patrice for speaking out about her pica, and meeting her has deepened my understanding of pica, including the impacts and implications for those affected and their families. 

Unless you know someone with pica, you may not have heard of it, and compared to other eating disorders, information about it is scarce. This is why I have written this article, to explain what pica is and how to manage it, particularly how to keep those who engage in it safe and well. I also want to increase awareness of pica, to reduce the feelings of shame or stigma that are often another impact of this poorly understood condition. 

 

What is pica? 

Pica is the eating of non-nutritive or non-food items. This means anything that is not a food could be a pica item; common items include:  
batteries, chalk, cloth, coins, foam, glass, hair, magnets, metal, paint, paper, plants, plastic, rubber, soap, stones, string, twigs, wood, wool.  

Some of these items are risky, and pica can cause serious harm; risks include, choking, poisoning, obstructions in the stomach or bowel, infections and damage to the mouth, teeth or gums. Tragically, there have been deaths associated with pica, although these are very rare, but it does highlight why understanding pica and learning how to manage it is so crucial. 

 

What causes pica? 

We still do not know exactly what causes pica, although we do have some ideas. This includes individuals having an iron or zinc deficiency, not understanding what is or is not a food, gaining a ‘reward’ from pica – eg a pleasant sensory or emotional sensation – and that pica increases when a person is stressed or anxious. For some people, pica can even act like an addictive behaviour, with the individual experiencing strong cravings for specific items. 

 

Why does pica occur in autistic people? 

Pica appears to be more common in autistic people, with or without a learning need. This is because autistic people are more likely to experience sensory and cognitive ‘differences’ and have more anxiety; all of which can contribute to developing pica. Autistic people are more likely to experience other eating issues as well as pica, such as ARFID or avoidant and restricted food intake disorder (Papini et al., 2024). This is the case for Poppy who has both; here she is describing her pica. 

“I see shiny objects and immediately salivate and want to feel them in my mouth. I have been using chewy jewellery to put the brakes on.”
Poppy, aged 13

Poppy’s description is brilliant. I can relate to her experience when she talks about her mouth watering for a pica item, like it would for a favourite food; although it is certainly not easy being an autistic teenager with pica. Positively, as Poppy gets older, she is more able to control the urge to engage in pica, and this is a good strategy. Let’s look at some other management ideas.  

 

Managing pica 

There are currently no national guidelines for interventions for pica in the UK; however, this does not mean that pica should not be managed. For many autistic people, their pica may have more than one cause and so several interventions might be needed.  

The first step is to request an assessment and diagnosis; this can be done via a GP or other health professional. Parents and carers can help by keeping a record of what is eaten and when and where this happens. This identifies risks which can be managed through processes such as risk and safety planning or safeguarding.  

For autistic people, it is essential that strategies for pica are neuroaffirmative or place the autistic experience at the centre of what we do. Here are some of the best strategies, separated into those that professionals can do and those which families or carers can do at home or in another setting.

 

For professionals: 

  • Work together to manage risk and share information. 
  • Provide access to physical health checks, eg blood tests for iron/zinc. 
  • Develop services for assessment/diagnosis and intervention.   
  • Record information in medical records, care and education plans.  
  • Seek additional training/resources.  

 

For parents/carers: 

  • Keep a look out for potentially dangerous items. 
  • Tell others, eg school, GP, health professionals.  
  • Provide safe alternatives, eg a pica-box.  
  • Request support from professionals and services. 
  • Distract away from pica and increase engagement in other activities. 

Top tip: Make a pica-box

Make a box containing a variety of safe edible items. These work best if they match as closely as possible the tastes or textures of pica items, eg crunchy vegetables/crackers instead of wood or other hard non-foods, rice paper instead of normal paper, strong flavoured items, eg yeast extract and chewy buddy toys.  

Small strategies really can make a big difference, and just like Patrice, speaking up about pica really helps to spread the word; the resources below can also help.