A mother in Longmont called us about her four-year-old and opened with an apology. She thought she was overreacting. He had always mouthed things, she said, and lately it had shifted to gravel from the driveway. That morning she found a small rock in his diaper.
She was not overreacting. What she described is pica, the repeated eating of items that are not food, and it deserves a same-week response.
Pica in autism sits in an awkward spot for families. Mouthing is so ordinary in early childhood that it is easy to shrug off, and much of the time it fades on its own. When it does not fade, or when what goes in the mouth moves from toys to dirt, paint chips, batteries, or metal, the risk changes completely.
Two things need to happen at once. The environment has to get safer today, and someone has to work out what the behavior is doing for your child. Skip the first and the second will not save you. Skip the second and the first becomes a permanent job.
What Is Pica, and How Does It Differ From Ordinary Mouthing?
Almost every young child puts non-food items in their mouth. The clinical question is what is going in, how often, and whether the child is swallowing.
The Line Between Oral Sensory Seeking and Pica
Oral sensory seeking usually means chewing. Shirt collars, sleeves, pencil tops, a chew necklace. The item goes in, gets worked over, and comes back out. That pattern is a form of stimming and is generally manageable with a safe chew alternative.
Pica means swallowing. Dirt, sand, paint chips, paper, hair, fabric, cigarette butts, small hardware, coins, and in some cases items that are genuinely dangerous. The DSM-5 criteria describe eating that persists for at least a month, is not developmentally appropriate, and is not part of a cultural practice.
The practical version we give parents is simpler. If your child is swallowing rather than chewing, if the items are getting smaller and more varied, or if you are finding evidence in diapers, treat it as pica and act accordingly.
How Common Pica Is Among Children with Autism
The best population data comes from the Study to Explore Early Development, a multi-site CDC study. In the 2021 analysis published in Pediatrics, pica was reported in 23.2% of preschoolers with autism compared with 3.5% of population-based controls. Among children with both autism and intellectual disability, the figure was 28.1%.
Two details are worth holding onto. Roughly one in four means this is not a rare problem. And the same study found pica in 14.0% of children with autism who did not have an intellectual disability, so a verbal child with strong cognitive skills is not automatically outside the picture.
Colorado families have a stake in that research. The paper was co-authored by researchers at the Colorado School of Public Health and the University of Colorado School of Medicine, both on the CU Anschutz campus in Aurora.
Why Pica Shows Up More Often in Children with Autism
Pica is rarely one thing. In most cases we assess, two or three contributors operate at once, which is why single-cause explanations fall apart within a week.
The Sensory Input the Mouth Provides
The mouth delivers strong, immediate, controllable input. Texture, temperature, pressure, taste, resistance. For a child seeking that kind of input, few alternatives compete.
This is the version parents most often recognize, and it tends to respond best to a replacement, provided the replacement matches what the child is after. A soft silicone chew will not satisfy a child seeking grit and crunch.
Communication, Attention, and Escape
Pica can also be maintained by consequences unrelated to taste. A child with limited ways to say no, ask for a break, or get an adult to come over quickly may find that swallowing something produces all three within seconds.
This pattern catches families off guard, because the behavior often increases when adults react strongly. That reaction is understandable and it can still be reinforcing the behavior. Sorting this out is what a functional assessment is for.
Medical and Nutritional Contributors
Iron deficiency, zinc deficiency, and gastrointestinal discomfort have all been associated with pica in the research literature. So has constipation, which is common in children with autism and can drive a range of unusual behaviors.
This is why we do not start a behavior plan for pica without a medical workup underway. Treating a nutritional deficiency behaviorally is slow and unnecessary when a blood test and a supplement would do it.
Colorado Exposure Risks Worth Knowing About
Pica risk depends on what is within reach, and what is within reach in Colorado differs from Florida or Ohio. Three things stand out here.
Lead Paint and Older Housing Stock
Lead-based paint and the dust it produces is the most common source of lead exposure in Colorado, and it is concentrated in homes built before 1978. Plumbing in homes built before 1986 can also contain lead. That covers a large share of the housing in central Denver, older neighborhoods in Pueblo and Colorado Springs, and the historic cores of Loveland and Greeley.
A child with pica in a pre-1978 home is in a different risk category than a child with pica in new construction in Castle Rock or Parker. Peeling paint on a windowsill, a chewable painted railing, or dust from a renovation all become ingestion routes rather than incidental contact.
Soil and Dust in Former Smelting Communities
Colorado’s mining and smelting history left metals in residential soil in specific places. The clearest example is the Colorado Smelter Superfund site in Pueblo, where lead and arsenic from a silver and lead smelter that operated from 1883 to 1908 settled into the soil of the Bessemer, Eilers, and Grove neighborhoods.
The EPA has been sampling and cleaning residential yards and indoor dust there, and reports finishing homes under the current cleanup goal in 2025.
If your child eats dirt and you live near a historic industrial area, raise that with your pediatrician by name rather than in general terms. Soil ingestion is a different exposure question than paint dust, and your county public health department may have neighborhood-specific testing resources.
Outdoor and Seasonal Exposures Specific to This Climate
Colorado’s dry climate and xeriscaped yards mean a great deal of exposed gravel, decomposed granite, and bare soil where other states would have turf. For a child who seeks grit, that is an almost unlimited supply, and it is present at most playgrounds and apartment complexes along the Front Range.
Winter adds its own list: magnesium chloride and other de-icers on sidewalks, ice melt pellets stored in garages, and antifreeze, all worth locking up before the first storm. Summer brings mulch, landscape rock, and cigarette butts in trailhead lots.
Safety Planning Before Treatment
Behavior plans take weeks. Environmental changes take an afternoon. When a child is swallowing dangerous items, the environment goes first.
Numbers to Keep Where Everyone Can See Them
Colorado is served by the Colorado Poison Center, operated by Rocky Mountain Poison and Drug Safety, a division of Denver Health that has run poison services since 1956. The line is 1-800-222-1222, it is free and confidential, and it is staffed around the clock.
Their standing guidance is worth memorizing: do not induce vomiting, do not try to neutralize anything, a sip of water is fine, and call the poison line right away. If your child develops breathing problems or becomes unresponsive, call 911 first.
Put both numbers on the refrigerator, in every caregiver’s phone, and in the school and daycare paperwork. A grandparent or babysitter should not have to look this up.
Items That Warrant an Emergency Room Rather Than a Phone Call
Most ingestions can be handled with a call. A few cannot, and these are worth recognizing on sight:
- Button batteries. The small round batteries in remotes, hearing aids, key fobs, thermometers, musical greeting cards, and light-up toys. These can cause serious internal burns quickly. Go to an emergency department immediately.
- More than one high-powered magnet. Magnets can attract through bowel tissue and cause perforation. Multiple magnets, or a magnet plus any metal object, is an emergency.
- Sharp objects, including glass, screws, nails, and broken plastic.
- Anything from a locked cabinet: medications, cleaning products, nicotine pouches, cannabis edibles, de-icer.
- Signs of obstruction after any ingestion: repeated vomiting, a swollen or hard abdomen, refusal to eat or drink, no stool, or unusual lethargy.
A Room-by-Room Sweep That Buys You Time
The goal is not a perfect house. It is removing the highest-risk items from the spaces where your child spends unsupervised minutes, and knowing which spaces those are.
- Move small batteries, magnets, and coins into a locked container rather than a high shelf. Children climb.
- Check windowsills, door frames, and radiators in older homes for chipping paint. Cover or repair rather than sand, which spreads dust.
- Walk the yard and the route to the car, noting gravel beds, mulch, cigarette butts, and landscape rock.
- Audit the car itself, including door pockets and seat backs, which are unsupervised space by definition.
- Give every caregiver the same list, including daycare, school staff, and relatives who provide regular care.
Getting a Medical Workup Started
A behavior analyst should not be the only professional on a pica case. The medical side runs in parallel, and in Colorado some of it is already built into standard pediatric care.
Blood Lead Testing for Colorado Children
The Colorado Childhood Lead Poisoning Prevention Program at CDPHE is the state’s resource here. Children enrolled in Health First Colorado, CHP+, or the Colorado Indigent Care Program are required to be tested at 12 and 24 months, and most private plans cover testing for children under six.
For a child with active pica, a single test at 12 months is not enough reassurance. Ask about retesting based on current behavior. CDPHE also offers a free in-home environmental investigation to locate exposure sources when a child’s blood lead result comes back above the state’s action threshold.
Iron, Zinc, and Gastrointestinal Evaluation
Ask about checking ferritin and iron studies, zinc, and hemoglobin. Raise constipation and any history of reflux, food refusal, or unusual posturing, since gastrointestinal discomfort is a recognized contributor.
Bring data. A two-week log of what was eaten, when, where, and what was happening beforehand will do more for that visit than a general description, and it becomes the baseline for any behavior plan that follows.
How ABA Approaches Pica
Behavior analysis has a substantial research base on pica, and also a poor record with generic plans. The work is specific to the individual child.
Starting With a Functional Assessment
Before anything is taught, we work out what the behavior produces. Sensory input the child is seeking directly? A reliable way to summon an adult? An escape from a demand? Is it worse when the child is bored, hungry, tired, or constipated?
A functional behavior assessment answers those questions with observation and data rather than assumption. The answer shapes the whole plan, which is why two children with identical-looking pica can need completely different approaches.
Building a Replacement That Competes
If the function is sensory, the replacement has to deliver comparable input and be available faster than the item being eaten. That usually means a menu of options rather than one chew tool, kept within arm’s reach rather than in a bag in the other room.
If the function is communication, the work is teaching a faster, more reliable way to get the same result. Requesting a break, asking for attention, or refusing a task, using speech, signs, pictures, or a device, depending on the child. Related daily-living work such as potty training often runs alongside this, since both depend on the same foundation of clear communication and consistent routines.
Visual supports and antecedent-based interventions are both on the list of evidence-based practices identified by the National Clearinghouse on Autism Evidence and Practice at the University of North Carolina, and both show up in most pica plans we write.
Supervision Planning Without a Permanent Emergency
Every honest pica plan includes a supervision component, and most families are already exhausted by it before we arrive. The aim is to define supervision precisely enough that it can be shared and eventually reduced, rather than leaving one parent on constant line-of-sight duty.
That means sorting environments into three groups: already safe, fixable, and requiring direct supervision for now. A family in Greeley with a swept living room and a hazardous back yard has a very different daily reality than one facing risk in every room.
What Progress Realistically Looks Like
Pica tends to respond gradually. Many children make meaningful progress with consistent intervention, and reduction is a more realistic first goal than elimination. Setbacks during illness, schedule changes, and transitions are common.
Be cautious with any provider who promises a timeline. Response varies by function, age, communication ability, and how much of the environment can realistically be modified. What we can commit to is measurement, so you know within a few weeks whether the plan is working.
Keeping Everyone on the Same Plan
Pica does not stay in one setting, and a plan that only runs at home produces confusing results. Consistency across caregivers is part of the intervention, not an administrative detail.
Getting Pica Into the IEP or 504 Plan
If your child is in school, pica belongs in writing: a behavior intervention plan attached to the IEP, supervision language for recess, lunch, and transitions, and a documented response protocol for staff. Our school-based team can help build the plan and train the adults carrying it out.
Ask specifically about the least structured parts of the day. Playgrounds, hallways, bus lines, and the arrival window before the bell are where the gaps usually are.
Consistency Across Home, Childcare, and Community
The same protocol needs to reach every setting your child spends time in. In-home ABA sessions address the house and yard. Daycare-based support carries the plan into a childcare classroom. For older individuals in group home settings, staff training and shared documentation do the same work with a rotating team.
Parent training is usually the piece that holds all of it together, because you are the one making decisions at seven in the evening when a plan meets real life. For younger children, early intervention can address pica while communication and routines are still forming, and weekend sessions help families who cannot add anything to a weekday.
If your child is swallowing non-food items, this week is the time to call your pediatrician, save the poison center number, and walk your house with fresh eyes. None of that requires a diagnosis, a referral, or a waiting list.
Pica in autism is serious, and it is also treatable often enough that it should not be carried alone.
Talk with our Colorado team. If pica is showing up at your house, we can help you build a safety plan and a treatment plan together.
FAQs
Is mouthing the same thing as pica?
No. Mouthing generally means chewing and releasing, and it is developmentally ordinary in young children. Pica involves repeatedly swallowing non-food items over at least a month. If your child is swallowing rather than chewing, or you find items in diapers or vomit, treat it as pica and call your pediatrician.
Will my child grow out of it?
Some do, particularly when pica appears early and mildly. Others do not, and pica can persist into adolescence and adulthood, especially alongside intellectual disability. Because the medical risks are serious and cumulative, waiting it out compares poorly with a workup and a plan.
Should I get my child’s blood lead tested?
Talk with your pediatrician and mention pica explicitly. Colorado requires blood lead testing at 12 and 24 months for children on Health First Colorado, CHP+, or CICP, and active pica may warrant testing beyond that schedule, particularly in a home built before 1978 or near a historic industrial site.
What should I do the moment my child swallows something?
Call the Colorado Poison Center at 1-800-222-1222 unless the situation is an emergency, in which case call 911. Do not induce vomiting. Button batteries, multiple magnets, and sharp objects need an emergency department right away rather than a phone call.
Does insurance cover ABA therapy for pica?
Pica is commonly addressed within an ABA treatment plan when documented as a target behavior. Coverage depends on your plan and the medical necessity documentation submitted. Our guides to ABA insurance coverage in Colorado, Health First Colorado, and what ABA costs here have the specifics, and our team can verify benefits for you.
Can ABA make pica worse before it gets better?
A temporary increase can happen when a behavior that used to work stops working, which is why safety planning comes first and why plans for dangerous behavior need close supervision and frequent data review. A sustained increase in unsafe behavior is a reason to revise the plan rather than push through.
Sources:
- Fields, V.L., Soke, G.N., Reynolds, A., Tian, L.H., Wiggins, L., Maenner, M., DiGuiseppi, C., Kral, T.V.E., Hightshoe, K., & Schieve, L.A. (2021). Pica, autism, and other disabilities. Pediatrics, 147(2), e20200462. DOI: https://doi.org/10.1542/peds.2020-0462 ·
- Colorado Department of Public Health and Environment. Prevent lead poisoning in kids (Lead Risk Questionnaire). https://cdphe.colorado.gov/lead/lead-health/quiz
- U.S. Environmental Protection Agency. Colorado Smelter Superfund Site: Site Progress. Updated April 28, 2026. https://www.epa.gov/co-smelter/site-progress.
- Colorado Poison Center / Rocky Mountain Poison and Drug Safety, Denver Health. https://www.copoisoncenter.org/
- Autism Speaks Autism Treatment Network / AIR-P. A Parent’s Guide to Managing Pica in Children with Autism. https://www.autismspeaks.org/sites/default/files/2018-08/Pica%20Parents.pdf
- CDC, Childhood Lead Poisoning Prevention. About Childhood Lead Poisoning Prevention. https://www.cdc.gov/lead-prevention/about/
- Pueblo County Department of Public Health and Environment. Lead Program. https://county.pueblo.org/public-health-department/lead-program
- National Clearinghouse on Autism Evidence and Practice, UNC Frank Porter Graham Child Development Institute. Evidence-Based Practices for Children, Youth, and Young Adults with Autism (2020). https://ncaep.fpg.unc.edu/
- Fields, V.L., et al. (2020). Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder: Study to Explore Early Development. Disability and Health Journal, 14(3), 101052. DOI: https://doi.org/10.1016/j.dhjo.2020.101052
- Colorado Department of Health Care Policy and Financing. Pediatric Behavioral Therapies. https://hcpf.colorado.gov/pediatric-behavioral-therapies-information-providers