Pica as a presenting symptom in childhood celiac disease.

Persistent pica may be either a cause or a result of iron deficiency. Three children are described with long-standing pica and iron-deficiency anemia and in whom total villous atrophy consistent with celiac disease was found on jejunal biopsy. Additional findings included short stature, delayed bone age, and impaired xylose absorption. A dramatic growth spurt and complete resolution of pica were observed after a gluten-free diet. In these cases pica evidently resulted from iron deficiency secondary to malabsorption. Underlying celiac disease should be considered in children with persistent pica and growth failure even if gastrointestinal disturbances are minimal.