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Vegetative disorder

Vegetative disorder may be defined as ‘abnormalities of vegetative functions e.g. eating, evacuation or sleep, either due to delayed maturation of bodily functions or abnormal psychosocial development’. However, some of them may have underlying organic etiology that needs to be excluded.

Pica, enuresis and encopresis are common Vegetative disorder in childhood, discussed here. Anorexia nervosa & bulimia are predominantly seen in adolescents, discussed elsewhere.

Pica i.e. perverted appetite, is the commonest Vegetative disorder, defined as “a pattern of eating non- nutritive substances for at least one month inappropriate to the child’s developmental level and culturally sanctioned practice “(DSM IV criteria).

The substances commonly ingested are clay or dirt (geophagia); paints, pencil-lead (plumbophagia), ice (pagophagia), starch (amylophagia), faeces (coprophagia), hair (trichophagia), plaster, ash, cloth, coal, soap etc.

Incidence: Pica is a normal developmental behavior till 18 months of age, when the infants have a tendency to mouth all objects within their reach. Persistence of pica beyond this age is abnormal, estimated to be present in — 20-30% of toddlers and – 10% of older children. Incidence is relatively higher in low-socioeconomic status, similar family history and institutionalized children.

Etiology

Although Pica is largely a behavioral disorder, it has been associated with Determinants of Child’s Behavior

a) Biologically inherent temperament: Easy vs. difficult (fussy) babies

b) Organic causes of Vegetative disorder: Chromosomal: Kleinfelter or Fragile X syndrome, Genetic: Phenylketonuria, Brain injury (Prenatal: CNS anomalies, Substance abuse – Per/natal: Birth asphyxia – Postnatal: Infections, Epilepsy), Physical/mental handicaps

c) Environmental causes of Vegetative disorder: Family factors (Parental personality, intelligence, education – Parent-child bonding (love/rejection) – Parental attitudes: Over-protection/discipline – Inconsistent parental behavior (confusion)), Extra-family factors (Social/economic discrimination – Frequent change of schools/residence – Stressful school environment – Peer-pressure – Effect of mass media, role models

d) Learning & conditioning influences retardation, b) emotional neglect, c) iron and zinc deficiency and d) worm infestations.

Complications in cases of Vegetative disorder: Children with pica are at risk for:

– GIT problems e.g. recurrent abdominal pain, diarrhea or worm infestation,

– Chronic lead poisoning, and

– Iron deficiency anemia. Rarely, these cases may develop bezoars, intestinal obstruction or perforation.

Diagnosis is clinical, though investigations e.g. hemogram (for anemia and infections) and stool examination (for worm infestations) are indicated in all cases. Serum lead estimation may be required in relevant cases.

DID of pica includes more serious psychological disorders e.g. autism, schizophrenia, and physical disorders e.g. Kleine-Levine syndrome.

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