Rumination Disorder

What Is Rumination Disorder?

Rumination disorder (also called merycism) 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 child will spit it out.

For a child to be diagnosed with the disorder:

  • The child must have been able to eat and digest without the issue previously, and not be due to another medication problem.

  • The problem must have been ongoing for at least a month.

Usually, the behavior happens while eating, or right after.

Because most children outgrow rumination disorder, and older children and adults with this disorder tend to be secretive about it out of embarrassment, it’s difficult to know exactly how many people are affected. However, it’s generally considered to be uncommon.

Rumination disorder happens most often in babies and very young children (between 3-12 months), and in children with cognitive impairments. It’s rare in older children, adolescents, and adults. 

 

What Are the Symptoms of Rumination Disorder in Babies and Kids?

Symptoms of rumination disorder in babies and young kids include:

  • Repeated regurgitation of food

  • Repeated re-chewing of food

  • Weight loss

  • Bad breath and tooth decay

  • Repeated stomach aches 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 themouth. These movements may be done as the infant is trying to bring back up the partially digested food.

Rumination Disorder Causes

The exact cause of rumination disorder isn’t 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 rely on self-comfort. For some children, the act of chewing is comforting.

  • It may be a way for the child to get attention.

  • It may be a sign of mental illness such as depression or anxiety.

Continued

Rumination Disorder Diagnosis

If a baby or child has symptoms of rumination, the doctor will begin an evaluation by performing a complete medical history and physical exam. 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 see how the behavior has affected their body by looking for signs of dehydration and malnutrition.

To help in the diagnosis of rumination disorder, the doctor may need to  review the child's eating habits. It's often necessary for the doctor to observe an infant during and after feeding.

Rumination Disorder Treatment

Treatment of rumination disorder mainly focuses on changing the child's behavior. Several approaches may be used, including:

  • Breathing exercises after eating

  • Changing the child's posture during and right after eating

  • Encouraging more interaction between mother and child during feeding; giving your child more attention

  • Taking away distractions during feeding

  • Making feeding a more relaxing and pleasurable experience

  • Distracting your child when the rumination behavior begins

  • Aversive conditioning, which involves placing something sour or bad-tasting on the child's tongue when they begin to vomit

Psychotherapy for the mother and/or family may be helpful to improve communication and address any negative feelings toward the child due to the behavior.

There are no medications used to treat rumination disorder.

Rumination Disorder Complications

Among the many potential complications associated with untreated rumination disorder in infants and children are:

  • Malnutrition

  • Less resistance to infections and diseases

  • Failure to grow and thrive

  • Weight loss

  • Stomach diseases such as ulcers

  • Dehydration

  • Bad breath and tooth decay

  • Aspirationpneumonia and other respiratory problems (from vomit that is breathed into the lungs)

  • Choking

  • Death

Rumination Disorder Prevention

There’s no known way to prevent rumination disorder in babies and children. However, careful attention to a child's eating habits may help catch the disorder before serious complications can occur.

Rumination Disorder Outlook

In most cases, babies and young children with rumination disorder will outgrow the behavior and return to eating normally. For older children, this disorder can continue for months.

WebMD Medical Reference Reviewed by Neha Pathak, MD on August 10, 2020

Sources

SOURCES:

American Academy of Pediatrics.

NEDA: “Rumination Disorder”

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