PE5.3 | Temper Tantrums and Pica — Summary & Reflection

KEY TAKEAWAYS

Temper tantrums are developmentally normal in toddlers (18 months–3 years) and are managed through parental education, planned ignoring, positive reinforcement, and consistent limit-setting — never by capitulation. Pica is the persistent ingestion of non-food substances for ≥1 month in children ≥18–24 months; it is most commonly associated with iron deficiency (especially geophagy and pagophagia) and neurodevelopmental conditions (intellectual disability, ASD). Every child with pica must be screened for iron deficiency (FBC, serum ferritin) and lead exposure (BLL). Iron supplementation resolves pica in most iron-deficient children. Lead poisoning (BLL ≥45 µg/dL) requires DMSA chelation, iron supplementation, and environmental remediation. Iron deficiency amplifies lead absorption via the DMT-1 transporter, creating a dangerous cycle that must be broken at both ends.

REFLECT

Consider the socioeconomic context of pica in India: a child who eats soil in a village may do so because iron-rich foods are unaffordable, the house has old lead paint, and the parents are unaware of the risks. How does the paediatrician's role extend beyond treating the individual child to counselling the family about the home environment and advocating for nutritional supplementation programmes? Kolb's abstract conceptualisation invites you to connect the biochemistry of iron deficiency → altered dopamine signalling → pica → lead absorption with the social determinants that make this cycle more likely in certain populations, and to consider what a comprehensive management plan looks like at both the individual and community level.