Rumination disorder is a feeding and eating disorder in which a person, usually an infant or young child, brings back up and re-chews partially digested food that has already done swallowed. In most cases, the re-chewed food is consumed again; but occasionally, the person will spit it out.
To be considered a disorder, this behavior must occur in a person who had previously been eating normally, and it must happen regularly — usually daily — for at least one month. The child may exhibit the behavior during feeding or right after eating.
Symptoms of Rumination Disorder
Symptoms of rumination disorder include:
- Repeated regurgitation of food
- Repeated re-chewing of food
- Weight loss
- Bad breath and tooth decay
- Repeated stomachaches and indigestion
- Raw and chapped lips
In addition, infants with rumination may make unusual movements that are typical of the disorder. These include straining and arching the back, holding the head back, tightening the abdominal muscles, and making sucking movements with the mouth. These movements may be done as the infant is trying to bring back up the partially digested food.
Causes of Rumination Disorder
The exact cause of rumination disorder is not known; however, there are several factors that may contribute to its development:
- Physical illness or severe stress may trigger the behavior.
- Neglecting an abnormal relationship between the child and the mother or other primary caregiver may cause the child to engage in self-comfort. For some children, the act of chewing is comforting.
- It may be a way for the child to gain attention.
How Common Is Rumination Disorder?
Since most children outgrow rumination disorder, and older children and adults tend to be secretive about it out of embarrassment, it is difficult to know precisely how many people are affected. However, it is generally considered to be uncommon.
Rumination disorder most often occurs in infants and very young children (between 3 and 12 months) and children with intellectual disabilities. It is rare in older children, adolescents, and adults. It may occur slightly more often in boys than in girls, but few studies of the disorder exist to confirm this.
Risk factors of Rumination disorder
Rumination disorder can affect anyone, but It’s the most seen in infants and children with intellectual disabilities.
Some sources suggest rumination disorder is more likely to affect females, but additional studies are needed to confirm this.
Other factors that may increase the risk of rumination disorder in both children and adults include:
- Having an acute illness
- Having a mental illness
- Experiencing a psychiatric disturbance
- Undergoing major surgery
- Undergoing a stressful experience
More research is needed to identify how these factors contribute to rumination disorder.
Diagnosed with Rumination Disorder
If symptoms of rumination are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. The doctor may use specific tests — such as imaging studies and blood tests — to look for and rule out possible physical causes for the vomiting, such as a gastrointestinal condition. Testing can also help the doctor evaluate how the behavior has affected the body by looking for signs of problems such as dehydration and malnutrition. However, the diagnosis established by the clinical description of signs and symptoms and invasive or costly tests (such as examining the stomach by endoscopy) is generally not necessary or helpful in making an accurate diagnosis.
To help in the diagnosis of rumination disorder, a review of the child’s eating habits may be conducted. It often is necessary for the doctor to observe an infant during and after feeding.
Treatment of Rumination Disorder
Treatment of rumination disorder mainly focuses on changing the child’s behavior. Several approaches may be used, including:
- Changing the child’s posture during and right after eating
- Encouraging more interaction between mother and child during feeding; giving the child more attention
- Reducing distractions during feeding
- Making feeding a more relaxing and pleasurable experience
- Distracting the child when they begin the rumination behavior
- Aversive conditioning, which involves placing something sour or bad-tasting on the child’s tongue when they start to regurgitate food
There are no FDA-approved medications to treat rumination disorder, but drugs may be used to treat associated symptoms
There are no medications used to treat rumination disorder.
Among the many potential complications associated with untreated rumination disorder are:
- Lowered resistance to infections and diseases
- Failure to grow and thrive
- Weight loss
- Stomach diseases such as ulcers
- Bad breath and tooth decay
- Aspiration pneumonia and other respiratory problems (from vomit that is breathed into the lungs)
Preparing for your appointment
You may start by seeing your or your child’s primary care provider. Or you may be referred immediately to a doctor who specializes in digestive disorders (gastroenterologist).
Here’s some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there’s anything that needs to be done in advance, such as fasting before a specific test. Make a list of:
- Symptoms, including any that seem unrelated to the reason for the appointment
- Essential personal information, including significant stresses, recent life changes, and family medical history
- All medications, vitamins, or other supplements you or your child take, including the doses
- Questions to ask the doctor
Take a family member or friend along, if possible, to help you remember the information you’re given.
For rumination syndrome, some basic questions to ask the doctor include:
- What’s the most likely cause of these symptoms?
- Are there other possible causes?
- Are any tests needed?
- Is this likely temporary or long-lasting?
- What treatment do you recommend?
- Are there any alternatives to the primary approach you’re suggesting?
- Are any dietary restrictions recommended?
- Do you have any brochures or other printed material about this condition? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
- When did the symptoms begin?
- Do symptoms occur with every meal?
- How severe are the symptoms?
- Does anything make your or your child’s symptoms better?
- Does anything seem to worsen the symptoms?