Occupational Therapy News OTnews February 2020 | Page 36

FEATURE EATING DISORDERS A strategy to combat Pica Rachel Peek explains how she has introduced a simple intervention to help children in a specialist school combat the eating disorder Pica R achel Peek is a newly qualified occupational therapist, working for the learning disabilities charity Together Trust in specialist schools for learning disabilities and emotional behaviour disorders. While based at a local primary school, she became interested in the eating disorder Pica, which is described as the persistent eating of typically non-edible items that do not provide any nutritional value. ‘Pica is a medical condition, which is often diagnosed by a medical professional and can occur in pregnancy, mental health conditions, learning disability, individuals lacking in iron and autism,’ she explains. ‘There are many risks around Pica, including vomiting, constipation, blockages of the gut or intestines, choking, poisoning and, in some cases, death, [but] the research shows that causes, assessment and strategies are very limited.’ Having being introduced to the concept of Pica by her line manager, who shared an article on the subject with her, Rachel began to reflect on the students on her caseload, and happened to glance out of the office window and notice some students sitting under a tree eating leaves and twigs. ‘There and then I decided to produce a list of students, with the help of some teachers and teaching assistants, that identified those children who were either diagnosed, or who usually seek out non-edible items, both in and out of the classroom environment,’ she says. ‘This resulted in the identification of around five students who displayed classic symptoms of Pica, with only one student who had been diagnosed with the disorder. The risks around Pica and the students identified concerned me, which prompted me to further search out interventions practised by occupational therapists.’ This led Rachel to an intervention used called a ‘Pica box’. This consists of a box, with multiple compartments, containing alternative food items to the non-edible items the individual is mouthing or ingesting. ‘I produced a list with information of what each child enjoyed eating, the texture of the item and appearance,’ she reflects, and then came up with alternatives for these objects in terms of appearance and texture.’ For example, instead of sticks, Rachel encouraged the children to consume vegetable sticks, celery and Twiglets. Sand was replaced with grape nuts/edible sand; gravel was substituted with crushed digestive biscuits and cornflakes; chalk with sweet hearts; hair with celery or crushed cracker; and leaves with spinach leaves, lettuce and crisps. 36 OTnews February 2020 Rachel’s ‘Pica box’ with the replacement edible food items ‘On production of the box, I labelled each item the individual ingested,’ she explains. ‘On the back of the lid I provided the teacher and teaching assistants with a small explanation of what a Pica box is. ‘The front included the student’s picture and a removable symbol, so that the student could ask for the box, and the back contained additional Pica strategies.’ After a small training session with the teachers and teaching assistants, Rachel decided to introduce the box to one student. ‘The student was sat in the playground eating sticks,’ she remembers, ‘so I offered a celery stick to the student asking her to drop the stick. The student consumed the celery stick and then tapped on the box asking for more. ‘This continued for a couple of minutes and resulted in the student having no interest in the inedible items. She requested the Pica box instead, by taking the symbol off the top and handing it to me.’ Following this initial positive response, Rachel was inspired to share the idea of Pica boxes with the wider team, and to continue producing Pica boxes for the other students she had identified as in need. ‘The risk factors around Pica are concerning and sharing of knowledge around this area is of great importance, as most research and intervention in practice is carried out in the US’ she concludes. ‘So, I am currently sharing this initiative around our trust and, hopefully, at our special interest group meeting in the North West in the near future.’ Rachel Peek, occupational therapist, learning disability services, Together Trust. Email: [email protected]