Pica in a Four-Year-Old Girl with Global Developmental Delay

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.