EC Paediatrics

Iron deficiency anemia (IDA) is among the most common nutritional disorders affecting children worldwide. While often overlooked, pica, the compulsive ingestion of non-food substances, can be an early clinical sign of IDA, which often prompts caregivers to seek medical evaluation. Although the exact cause of pica is unclear, it may be linked to altered brain signaling and can worsen iron deficiency by displacing healthy foods or causing minor gastrointestinal bleeding. We report a case of a 2-years old boy of Asian descent, who presented with IDA and an unusual pica behavior: persistent cloth-chewing and sucking (Textilophagia: Textile: fabrics, phagia: eating or consuming). Initial psychiatric evaluation ruled out autism spectrum and other psychiatric/behavioral conditions. Symptoms of anemia and textilophagia both improved on oral iron therapy. This case illustrates the crucial role of thorough history-taking, focusing on detailed dietary habits and questioning unusual behaviors in the diagnosis and management of iron deficiency anemia in young children.

 Keywords: Iron Deficiency Anemia; Nutritional Deficiency; Oral Iron Supplementation; Textilophagia; Pica

1. World Health Organization. “Iron deficiency anaemia: assessment, prevention, and control. A Guide for Programme Managers”. World Health Organization (2001).
2. Borgna-Pignatti Caterina and Silvia Zanella. "Pica as a manifestation of iron deficiency”. Expert Review of Hematology 9 (2016): 1075-1080.
3. American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders: DSM-5”. American Psychiatric Publishing (2013).
4. Miao Duo., et al. "A meta-analysis of pica and micronutrient status”. American Journal of Human Biology1 (2015): 84-93.
5. Fields Virginia L., et al. "Pica, autism, and other disabilities”. Pediatrics2 (2021): e2020011837.
6. Lozoff Betsy., et al. "Long-lasting neural and behavioral effects of iron deficiency in infancy”. Nutrition Reviews2 (2006): S34-S43.
7. Reynolds Robert D., et al. "Pagophagia and iron deficiency anemia”. Annals of Internal Medicine3 (1968): 435-440.
8. Sayetta Richard B. "Pica: An overview”. American Family Physician5 (1986): 181-185.
9. Ganesan Preetha R and Anthony A Vasauskas. "The association between pica and iron-deficiency anemia: A scoping review”. Cureus 4 (2023): e37904.
10. Schnitzler Erik. "The neurology and psychopathology of pica”. Current Neurology and Neuroscience Reports8 (2022): 531-536.
11. Emond Alan., et al. "Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders”. Pediatrics 2 (2010): e337-e342.
12. Matson Johnny L., et al. "Pica in Persons with developmental disabilities: treatment approaches”. Research in Developmental Disabilities9 (2013): 2564-2571.
13. Ning Shasha and Michael P Zeller. "Management of iron deficiency”. Hematology: American Society of Hematology Education Program 1 (2019): 315-322.