Pica in a Four-Year-Old Girl with Global Developmental Delay_2015.pdf

CASE: Emily is a 4 and half-year-old girl whose foster mother is concerned about her odd eating behaviors.
Emily has been with her foster mother for 1 year after exposure to domestic violence. Emily’s habit of eating
nonfood items led to her foster mother providing “100% supervision.” Emily constantly picks up, smells, and
tastes nonfood items, particularly rocks and things made of metal. She “explores everything with her
tongue.” Emily scoops dirt and gravel from sidewalk crevices into her mouth. Although toileting, she catches
and licks urine in her hand and searches for stool to put in her mouth. With redirection, Emily stopped putting
feces into her mouth, but after spending time with her biological family, this behavior recurred.
Emily does not like to eat foods that are hard or require chewing. She does not choke or gag on solid foods
or liquids. She likes foods that are sweet. She refuses to eat vegetables and foods with certain textures. Emily
pulls food apart with her hands before putting it in her mouth.
Emily has global developmental delay, cerebral palsy, contractures in her legs, and strabismus. A medical
workup resulted in a diagnosis of trisomy 4p and monosomy 9p. Emily works with a physical therapist and
occupational therapist; she attends preschool in a special day class. She is an alert, playful, and socially
engaging girl who walks with an abnormal gait, speaks in short sentences, and follows simple directions.