Should Pica Lead to Consideration of Lead Poisoning?

Figure – The multiple round densities visible on this 4-year-old boy’s abdominal radiograph probably represented pebbles that he had ingested. The mother had noticed pebbles in her son’s stool, and laboratory studies revealed iron deficiency. Pica was diagnosed.

In their Photoclinic case of iron deficiency in a 4-year-old boy with pica (CONSULTANT FOR PEDIATRICIANS, March 2009, page 104), Drs Ron Shaoul and David Bader do a commendable job of describing pica and of documenting the child’s iron deficiency (Figure). However, I was surprised that the possibility of lead poisoning was not considered. Perhaps lead poisoning is not a common problem in Israel, but pica of this degree should lead pediatricians in the United States to have serious concerns about plumbism.

-- John W. Blanton Jr, MD
Guilford, Conn

I agree with Dr Blanton that lead poisoning should be included in the differential diagnosis in these circumstances. Nevertheless, the rareness of lead poisoning in Israel, together with the fact that this child’s condition resolved with iron administration, makes a diagnosis of lead poisoning very unlikely in this case.

-- Ron Shaoul, MD
Director, Pediatric Gastroenterology Unit
Meyer Children’s Hospital
Rambam Medical Center
Haifa, Israel