Question:

I have a three and a half year old boy. He has a twin sister and a brother who is one year older. My concern is that he chews everything, I mean everything! He did have mild anemia which was quickly corrected over a year ago and we keep tabs on his hgb. We cannot keep, books, puzzles, paper, foam toys, wooden toys, plastic without him destroying it. He wrecks his siblings belongings also. This means there are less educational materials around the house for the other children. He is to start junior kindergarten in the fall and I am afraid they'll ask him to leave. We are at our wits end. Otherwise, he is a normal, very active pre-schooler. We have been giving him time outs which of course do not work. I am not sure that he is always conscious of what he is doing.
Help!

Hi. Your question was referred to the medical questions section of Ask a Specialist because this question is more appropriate for a pediatrician than a behavioral specialist. The question is interesting and unusual. There is certainly more information that I would like to know.

I would like to know the “history” of this chewing. When did it begin and how? How long has it been a problem? Does he just chew the material or does he actually eat it? What happens when you take the chewed object away from him?

There are also things I’d, were we in the office, ask about him. Is he particularly anxious? Does he have any other unusual symptoms? Does he eat well and is his nutrition good? Does he say anything about his desire to chew non-food items.

I would also like to know what you have tried other than removing the items and checking him for anemia. What was his response to your attempt to change his behavior? Have you tried giving him (substituting) something acceptable to chew? What was the reason for his anemia? Has his serum iron been measured?

I would start then with a list of possibilities for why he is doing this and then weed through them with the answers to your question.

There is a medical term for the behavior of eating unusual objects, paper, dirt, wood. This is called “pica”. You may have heard of it. Some physicians feel that it is associated with nutritional deficiencies such as Iron. Just because your son’s hemoglobin is normal doesn’t mean that he is not Iron deficient. Your pediatrician should check for iron deficiency and check your sons overall nutritional status.

Pica can also be associated with some developmental difficulties such as mental retardation or autism. I assume from what you say that this is not the case. I would think, given normal development, that a 3 year old would be willing to share why he is chewing.

When you read about pica, it states that it goes away with patience and time and the main concern should be the child getting sick by eating something that will cause difficulties with their bowels or is poisonous. I trust that these things are put away out of reach.

If he is not nutritionally deficient or have “pica” then I would look for a behavioral reason for his chewing. One would have to look at when it occurs and what he seems to be trying to express when he does it. Is he anxious? Is he bored? Is the behavior comforting. Would he accept a substitute chew object such as a teething ring? If this is anxiety then one would try to find the cause of and treat the anxiety. Often substituting other interesting and acceptable behaviors will rectify the situation.

Please let me know if you have more questions and how this turns out for your son.