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

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