Mental Health: Rumination Disorder

Rumination disorder is an eating disorder in which a person -- usually an infant or young child -- brings back up and re-chews partially digested food that has already been swallowed. In most cases, the re-chewed food is then swallowed 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 occur on a regular basis -- usually daily -- for at least 1 month. The child may exhibit the behavior during feeding or right after eating.

What Are the 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.

What Causes 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
• Neglect of or 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 with this disorder tend to be secretive about it out of embarrassment, it is difficult to know exactly 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 in children with mental retardation. 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.

How Is Rumination Disorder Diagnosed?

If symptoms of rumination are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. The doctor may use certain tests -- such as X-rays 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.

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.