Rachel Peek, an occupational therapist at the Greater Manchester based charity the Together Trust, has been working recently to tackle eating disorder Pica amongst local vulnerable children.
Pica is characterised by a tendency to eat substances that provide no nutritive value such as soil, chalk, hair or paper. The condition can affect a number of groups, including those who have a learning disability and people with autism. People suffering with Pica run the risk constipation, vomiting, choking, poisoning and blockages to the gut or intestines.
Rachel said: “I first became interested in Pica when my line manager gave me an article detailing a case in which a young man suffering with the condition died. That set me thinking about the children I work with in local schools that specialise in helping vulnerable children with complex needs. Working with teachers and teaching assistants I drew up a list identifying students who had either already been diagnosed, or who often sought out non-edible items. We found five children who manifested classic Pica symptoms, only one of whom had a pre-existing diagnosis.” 
Next, Rachel began to research appropriate interventions practised by occupational therapists, which is how she discovered the Pica box. A Pica box contains multiple compartments, each of which contains food items that are designed to be a substitute for specific non-edible items that a person has been observed eating.
“When I read about the Pica box I knew that this was an intervention I could introduce to the children I was working with, so the next step was a trip to my local DIY store, where I bought a plastic box into which I fitted some compartments. We’d already compiled a list of the non-edible items the children most often ingested and into each compartment I put edible alternatives, in terms of both appearance and texture. For example twigs were replaced with vegetable sticks, Twiglets and celery sticks. Leaves were replaced with spinach leaves and crisps; sand with grape nuts and gravel with crushed digestive biscuits and cornflakes. I filled that first prototype box with the edible alternatives, labelling each item and listing what non-edible item it was replacing and I put the picture of the first student we were working with on the front of the box. On the back of the lid I posted a short explanation of what a Pica box is, for the teachers and teaching assistants, along with some additional Pica strategies. Then came the moment of truth. I approached the student, who was sat in the playground eating twigs, and I offered her a celery stick and asked her to drop the twig. Not only did she do so she also tapped the box when she’d finished the celery stick and asked for more!”
This continued for several minutes, after which the child lost all interest in eating non-edible items and instead asked for the box by taking off a removable symbol from the lid, which was designed to help a child ask for the box in a simple and easy way.
Following this first success Rachel held a training session for teachers and teaching assistants and shared the idea with her colleagues in the occupational therapy team. She has also continued to make boxes for other children she has identified as being at risk from Pica.
Jill Sheldrake, Service Director at the Together Trust said: “Rachel may only have been with us as an occupational therapist for a year but she’s actually been working for the Together Trust for more than seven years, having started off as a support worker. Through hard work and determination she’s made the most of the opportunities available within the charity. With work like this she’s not only continuing to progress in her career but she’s also making an important contribution to furthering awareness of Pica, both at the Together Trust and in the wider professional community. We couldn’t be more proud of her.”
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