1 March 2003

Dear Editor,

Pica, the craving for unnatural articles of food, is associated with iron deficiency1,2. The word pica is derived from the Latin word for magpie, a bird renowned for eating a variety of food and non-food articles. The mechanism of pica in iron deficiency is not understood. Iron replacement results in a rapid resolution of symptoms well before improvement of any associated haematological abnormalities.

We present the unusual case of a young girl presenting with a compulsion to eat Velcro and found to be iron deficient.

A 2-year-old girl of Turkish background presented to her local doctor with a history of several months of repeated Velcro ingestion. Velcro could be found on a number of the young girl's clothes and toys and she demanded that her parents cut off the Velcro for her to eat. She would chew and swallow both sides of the Velcro tape. There were occasional complaints of abdominal pain but the child passed regular bowel motions containing small amounts of the undigested Velcro. There was no significant past history. The child's diet was predominantly cows’ milk, drinking up to 750 mL per day. Her weight gain was adequate. There was no history of blood loss and the child was reported to be developing normally. Apart from notable pallor, examination was unremarkable. Full blood examination demonstrated a microcytic, hypochromic anaemia (mean corpuscular volume = 67 fl) with a haemoglobin of 67 g/dL. Iron studies showed a serum iron of <2 µmol/L and iron binding saturation of 1%. Ferritin was <2 µg/L. No abnormal bands were demonstrated on haemoglobin electrophoresis. The patient was commenced on iron supplementation (6 mg/kg/day). The parents reported a decrease in Velcro ingestion over the following 2 weeks with regular administration of iron but compliance with the iron supplementation decreased after that time. A repeat full blood count 3 months later showed morphological changes of persistent iron deficiency. Repeat serum iron and ferritin were low.

Pica typically involves craving for salty or crunchy foods and may occur in up to 50% of patients with iron deficiency2. To the best of our knowledge the ingestion of Velcro has not been reported as a substance ingested by patients with pica and iron deficiency. The physical texture and ubiquitous distribution of Velcro may favour ingestion by iron deficient children.

Unfortunately iron deficiency remains a common paediatric problem in both developed and developing countries. It is now recognized that iron deficiency is a multisystem disorder with profound and irreversible effects on the developing neuro­logical system3,4.

Pica is a fascinating manifestation of this serious disorder and ingestion of unusual substances should alert the practitioner to search for underlying iron deficiency.