History Of Pica Research Articles

Pica patterns, toxocariasis, and elevated blood lead in children.

Blood samples were obtained during a lead screening program from 100 children aged 1-6 years in Allegheny County, Pennsylvania, to determine whether there was any association between specific forms of pica and infection with Toxocara canis, the principal cause of visceral larva migrans in the United States, or elevated blood lead levels. Significant associations were found between: 1) feces, soil, or grass pica and Toxocara infection; 2) paint or plaster pica and elevated blood lead; and 3) dog ownership and Toxocara infection. These findings suggest that an accurate pica history may be useful in identifying potential health problems in children.

Human toxocariasis in a rural community.

A questionnaire and serologic survey of a Pennsylvania community revealed that 23 (54%) of 43 study participants had antibody titers to Toxocara canis (enzyme-linked immunosorbent assay test [ELISA]) in the range defined as positive (greater than or equal to 1:32). Age-specific seropositivity rates were highest among adults (greater than or equal to 18 years). Positive titers ranged from 1:32 to 1:512. Seropositivity did not cluster by family, and seropositivity rates were significantly higher than those of a control group. Physical examination and laboratory tests designed to detect clinical signs of toxocariasis were performed on individuals with positive ELISA titers. Nine of 23 had a history of pica, seizures, or chronic pulmonary symptoms; however, physical examination revealed no abnormalities. Although medical examination and laboratory tests revealed a few abnormalities, neither the visceral larva migrans syndrome nor the ocular lesions characteristic of those produced by Toxocara sp were observed in any individual. We conclude that although certain populations may have high seropositivity rates to Toxocara antigens, indicating previous infection, clinical diseases may be uncommon.

Differential Diagnosis of Hypochromic Microcytic Anemia

Abstracts| January 01 1980 Differential Diagnosis of Hypochromic Microcytic Anemia Pediatr Rev (1980) 1 (7): 196–222. https://doi.org/10.1542/pir.1.7.196 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Differential Diagnosis of Hypochromic Microcytic Anemia. Pediatr Rev January 1980; 1 (7): 196–222. https://doi.org/10.1542/pir.1.7.196 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsPediatrics In ReviewPediatricsHospital PediatricsNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search The only hypochromic microcytic anemias in young children are iron deficiency, lead poisoning, and thalassemia. Clinical features helpful in the diagnosis include the following. Iron deficiency: peak incidence from 1 to 2 years of age, diet deficient in iron, or ingestion of more than one quart of milk per day. Alpha-thalassemia trait: occurs in any age group and predominantly in Oriental, black, and Mediterranean races. Beta-thalassemia trait occurs in children more than 6 months of age and predominately in black and Mediterranean races. Lead poisoning: peak incidence from 6 months to 4 years of age and a history of pica. It occurs largely in urban children. Topics: microcytic hypochromic anemia, iron deficiency, lead poisoning, alpha-thalassemia, beta thalassemia trait, diet, iron, microcytic anemia, signs and symptoms, thalassemia This content is only available via PDF. Copyright © 1980 by the American Academy of Pediatrics1980 You do not currently have access to this content.

Differential Diagnosis of Hypochromic Microcytic Anemia

The only hypochromic microcytic anemias in young children are iron deficiency, lead poisoning, and thalassemia. Clinical features helpful in the diagnosis include the following. Iron deficiency: peak incidence from 1 to 2 years of age, diet deficient in iron, or ingestion of more than one quart of milk per day. Alpha-thalassemia trait: occurs in any age group and predominantly in Oriental, black, and Mediterranean races. Beta-thalassemia trait occurs in children more than 6 months of age and predominately in black and Mediterranean races. Lead poisoning: peak incidence from 6 months to 4 years of age and a history of pica. It occurs largely in urban children.

Increased Lead Burden and the Energy Crisis

The present report describes a child with increased lead burden due to inhalation of fumes from lead-base-painted wood burned in an old faulty furnace. A 5-year-old boy was referred while asymptomatic with a blood lead level of 67µg/100 ml (atomic absorption). He had no history of pica or abnormal behavior. Physical examination revealed a small, alert, thin white boy whose physical and neurological examination were normal Hemoglobin and urinalysis were normal. Radiographs of the abdomen, left knee, and right elbow were normal.

Cravings and aversions during pregnancy

100 primiparae were studied in order to establish the prevalence among them and the nature of cravings and aversions for certain articles of diet not normally compulsively longed for or disliked. Either or both were found to occur frequently, even more often together than separately. As observed by others the commonest craving was for fruit and the commonest aversion for tea or coffee, although the total catalogue of substances in either category is lengthy. It was also noted that substances craved for were rarely those for which aversion was felt and that the two categories of foodstuffs were more or less distinct. The commonest craving was for fruit and for sweet, sour, or sharp-tasting foodstuffs. It was felt, although cravings and aversions are almost certainly closely related to one another, that cravings are more probably the outcome of an impaired sense of taste in pregnancy, whereas aversions may have more to do with alteration in the sense of smell. An attempt to relate the occurrence of cravings and aversions to a large number of other factors relevant to pregnancy suggested several positive relationships. These included a history of pica and of food-fads during childhood, a history of change in appetite in response to emotional stress, and habits in regard to smoking and drinking alcohol. As all these may be considered as forms of oral behaviour, it is felt that their occurrence in some women with cravings and aversions may indicate a predisposition probably due to a degree of oral fixation.

Pica in Turkey: I. The Incidence and Association with Anemia

The relationship of anemia to pica was investigated in 182 Turkish villagers. The presence of anemia was detected by hemoglobin determinations and stained peripheral blood films. The average hemoglobin concentration of sixty-nine control subjects of all ages without a history of pica was 13.0 gm. per 100 ml.; 17 per cent were anemic. The average hemoglobin concentration of seventy-three persons of all ages with pica was 9.8 gm. per 100 ml. and 64 per cent of this group was anemic. Anemia associated with pica appeared to be reversible since the average hemoglobin level of forty subjects who were former dirt or clay eaters was 12.6 gm. per 100 ml. and only 20 per cent had anemia. A further breakdown of anemia related to age and type of pica is included. Factors which might influence the cause for pica are discussed. Clay eating in women appears to be largely habit; many factors are probably involved in dirt and plaster pica.

The prevalence of pica.

YOUNG CHILDREN are well known to mouth or ingest substances that are not normally regarded as edible, and this is recognized to be a normal phase of development. Persistence of the activity of ingesting non-edible substances after the age of 18 months has been regarded as abnormal (Lourie et al 1 ), and the term has been applied to this. Parents often regard the practice as being relatively benign; however, associated hazards that have been reported include lead and infestation with parasites. It has been claimed that 24% of children with pica also had probable lead poisoning (Jacobziner and Raybin), 2 and a high level of blood lead was found to be related to a history of pica more often than to any other commonly employed parameter used in the detection of lead (Bradley et al). 3 An example of parasitic infestation is that of toxocariasis following pica

ENVIRONMENTAL FACTORS IN CHILDHOOD LEAD POISONING.

In a series of 906 children contacted by door-to-door survey, information was obtained on pica and environmental factors related to lead poisoning, and urine samples were analyzed. Urine was abnormal for lead and coproporphyrin in 216 of 801 children living in old housing and in 3 of 105 children of similar socioeconomic background living in a new housing project. Thirty-eight children from old housing, but none from new housing, had significant evidence of lead intoxication. A history of pica for paint, dirt, or plaster was obtained more frequently in the old housing but was not an adequate screening test for lead intoxication. Flaking paint on the inside of the home was the environmental factor most frequently associated with an abnormal urine.

The sequelae of pica with and without lead poisoning. A comparison of the sequelae five or more years later. I. Clinical and laboratory observations.

In spite of intense medical and sociologic effort, the incidence of lead poisoning remains high among children in many areas of the United States and the case fatality rate of lead encephalopathy continues to be approximately 25%. Of the survivors of pediatric plumbism, many have been reported to have significant residuals. Because the symptoms and signs of childhood lead intoxication may be vague or may mimic other common disorders, the diagnosis can be fraught with difficulty. During the past ten years in Cincinnati, a period in which 273 cases of excessive lead absorption have been documented among children, it has been observed repeatedly that a child initially may be labeled as having lead poisoning on the basis of a history of pica together with other signs and symptoms of possible lead intoxication, only to have analytic studies of the lead content of the objects chewed and of the child's blood

REPORT OF SUBCOMMITTEE ON ACCIDENTAL POISONING

LEAD INTOXICATION occurs most frequently in children between 1 and 3 years of age. (In the various series of cases reported in the literature approximately 85% of the cases were first diagnosed in the children in this age range.) For reasons not completely understood approximately 80% of symptomatic cases occur during the summer months. With rare exceptions children exhibiting clinical lead intoxication reside in the older sections of urban areas where they may have ready access to crumbling, peeling or easily chipped paint. Lead pigment paints were widely used for indoor painting until approximately 25 years ago. Lead pigments are still found in exterior paints, particularly those specified as mildew suppressants. Since the absorption of lead from the intestine proceeds slowly a child must nibble upon these flakes for several months before a quantity of lead sufficient to produce toxic manifestations is absorbed into the body. The child need ingest only a few chips each week; but if he continues this practice for longer than 3 to 6 months the clinical manifestations of lead intoxication to be described may occur thereafter, especially during the summer months. Although a history of pica may be a valuable question to ask in public health surveys, one must not overlook the possibility of pica even when it is denied. It is important for the clinician to realize that mothers may or may not observe their children eating a paint chip now and then. Even when they do see it they may not attribute much importance to the ingestion of the paint. If the clinician strongly suspects the possibility of lead poisoning he should proceed with the necessary laboratory diagnostic steps.

THE CONCENTRATION OF LEAD IN PLASMA, WHOLE BLOOD AND ERYTHROCYTES OF INFANTS AND CHILDREN

The concentration of lead in the blood of 103 infants and children without history of pica or lead poisoning, ranging in age from 5 hours to 13 years, was studied. The children were divided into three groups according to age: Group I, 5 hours to 6 months of age; Group II, 6.1 months to 4 years of age; Group III, older than 4 years. The values obtained in Group I were significantly lower than those obtained in Groups II and III. Groups II and III showed approximately the same content of lead in whole blood and erythrocytes. The median values in Group I were 0.015 mg/ 100 ml of whole blood and 0.034 mg/100 ml of erythrocytes. In the combined Groups II and III median values in whole blood were 0.027 mg/100 ml, and in erythrocytes 0.065 mg/100 ml. The range in Group I was 0.005-0.031 mg/100 ml of whole blood and 0.010-0.090 mg/100 ml of erythrocytes. In the two groups more than 6 months of age, the range for whole blood was found to be 0.003-0.054 mg/100 ml, and for erythrocytes 0.003-0.144 mg/100 ml; 90% of the values were between 0.015 and 0.040 mg/100 ml (whole blood), and between 0.028 and 0.103 mg/100 ml (erythrocytes). Significant amounts of bead were found in the whole blood (0.007-0.028 mg/100 ml), and erythrocytes (0.010-0.044 mg/100 ml) of newborn infants.

The incidence of abnormal blood levels of lead in ametropolitan pediatric clinic: With observation on the value of coproporohyrinuria as a screening test

Summary 1. Six hundred four children, aged 7 to 60 months, were examined for qualitative urinary coproporphyrin III. 2. Positive coproporphyrin of 2 plus or more was found in 197. 3. Blood lead determinations, x-rayof long bones, hematologic examinations, and a complete history and a careful physical examination were done on all those with positive coproporphyrinuria and in 136 subjects with negative coproporphyrinuria. 4. The mean blood lead for the two group was 0.043 mg. per cent. 5. The upper limit of normal blood lead seems to be 0.05 mg. per cent as at this value and above there was an increase in symptoms and findings ascribed to lead intoxication, though serious lead intoxication can in some individuals occur at lower values. 6. There was no significant difference of blood lead or other findings of lead intoxication in the patients with or without coproporphyrinuria. 7. Abnormal blood lead values were found in 44.4 per cent of the 333 children studied. 8. A history of pica was noted in69.6 per cent of the children with a blood lead of 0.05 mg. per cent or higher. This one finding gave higher correlation with blood lead than any other single test or symptom. 9. These findings suggest that childrenliving in other metropolitan areas where lead paint has been used in the house for many years should be investigated for evidences of lead poisoning.

Emotional Factors in the Etiology and Treatment of Lead Poisoning

In order to treat lead poisoning in children adequately, it is necessary to consider the factors which cause children to ingest lead-containing substances. Frequently children hospitalized for lead poisoning are treated for their medical illness, only to return with the same history, and it is found that they have continued to ingest substances containing lead. Six cases of lead poisoning admitted to Children's Hospital have been studied from the psychiatric aspects. In all of the cases, a history of pica (an abnormal appetite for substances not fit for food) was present. Children go through a period in their development, beginning at about age 6 months, when it is normal for them to put objects in their mouths. This period ends at about the age of 12 months. Gesell 1 states, Oral patterns become more or less restricted to the feeding situation at about the end of the first year; toys