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Pica and Autism: Mouthing of Things in Children

Dr. Mary Barbera

Many kids with autism exhibit pica behavior, which means they mouth, chew on, or ingest things that aren’t edible. This can be extremely dangerous as kids often eat or mouth things that are either unsanitary or unhealthy in some way, or even objects that are sharp that could potentially lead to internal injuries. Today I’m sharing a small excerpt from a recent live Q&A session discussing pica and autism.

How to Get a Child to Stop Putting Things in His Mouth

One of our members asked, “I just completed Module 2 of your course and I’m a little confused. My son has a problem behavior of putting things in his mouth, but I can’t understand how to use positive reinforcement to prevent it. Should I stop him from going to the playground? How do you use positive reinforcement?”

This little boy, who is 2 ½, is eating dirt and mulch from the playground. That is a big problem. There is a term we use called pica, and that means ingesting, eating, and chewing on inedible things. It can be a life-threatening problem and it is usually classified as self-injurious behavior. It’s a big problem because some kids swallow things like nails or glass or even mulch and dirt. Even if a child inadvertently swallows things, they could be putting things in their mouths that are really dangerous and could perforate their bowels or do even more harm. It’s not something we can treat lightly at all.

I ethically would recommend that parents and professionals not work through this on their own. Find a behavior analyst locally who can help you assess the situation. Or work with a physician, a psychiatrist, neurologist or even the child’s general pediatrician to come up with a plan medically and behaviorally to treat pica.

Stop Pica Behaviors in Autism

I will say that chewing behaviors, like just chewing your shirt, pencils, or toys, was a problem that Lucas had. It also was a problem that several of my clients had. Medically, we need to rule out vitamin and mineral deficiencies as well as lead levels. I would not just treat it behaviorally because there is some research to show that kids on the spectrum sometimes have an incorrect ratio of zinc to copper inside their body. I have read that zinc deficiency can cause chewing problems. Definitely do a zinc blood test. Talk with your child or client’s doctor about what testing they might need and what medications might help. I did a video blog specifically on the topic of medications and the zinc to copper ratio.

Copper in kids with autism can be a problem. If the copper level gets high and the zinc level is already low, it can cause aggression and irritability. I was giving Lucas multivitamins because he was such a poor eater, and he started having irritability within 30 minutes of giving him a multivitamin. I figured out his multivitamin had copper in it and as soon as I stopped giving it to him the irritability went away. Make sure if you are giving multivitamins, that there’s no copper in the multivitamin.

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Pica and Autism Assessment

We also need to assess when the chewing behavior occurs. To answer the member’s question about the playground, if the child only eats stuff when he’s at this playground, whether its mulch or something else, then I would stop taking him to that playground – at least until you learn how to get him to attend to materials and how to not chew on stuff within the home. Because once you get out in the community, now you’ve got a bunch of other variables. And if somehow this specific mulch or this specific environment is triggering this chewing and it doesn’t occur anywhere else, then yes, I would stop going at least temporarily until you figure out what’s going on.
To recap, assess when the chewing happens, what materials a child chews and then also why he chews. Is it when he’s not engaged? Is it, when he’s hungry? What does his feeding look like normally? I remember somebody asking me for my opinion about a boy who was eating dangerous things and had to have surgery for the removal of some object that he ate and he couldn’t pass on his own. One of the first things that an expert in pica and autism said was, what is his diet normally? What does he normally eat and normally drink?

Help for Pica and Autism

Module four of the toddler course on eating and drinking should be very helpful for pica and autism questions. You want to treat pica behavior like it’s a problem behavior.
Once you assess, then you make a plan. That could be to stop going to that playground, or carrying something to the playground like an iPad where the child would have his hands full so he won’t be tempted to chew on the mulch. He’d have a nice reinforcement as you pair up not eating things with the iPad or some other game. I wouldn’t try to get him to play on the equipment at the playground unless he loves it. If he loves it, then I would try to catch him when he comes down the slide. Keep him moving and don’t let him loiter around and start grabbing things.

For more information about pica and autism, you can attend a free online workshop by going to marybarbera.com/workshops. Whether you are a parent or a professional, there is help for you out there.

Free Workshop to Learn to Turn Autism (or Signs of Autism) Around

Want to start making a difference for your child or clients?
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