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 one 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 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.
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 exam. The doctor may use certain 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 is mainly established by the clinical description of signs and symptoms, and invasive or costly tests (such as examining the stomach by endoscopy) are 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.
How Is Rumination Disorder Treated?
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 he or she begins the rumination behavior
- Aversive conditioning, which involves placing something sour or bad-tasting on the child's tongue when he or she begins to regurgitate food
Psychotherapy (a type of counseling) 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.
What Complications Are Associated With 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)
What Is the Outlook for People With Rumination Disorder?
In most cases, infants and young children with rumination disorder will outgrow the behavior and return to eating normally. For older children, this disorder can continue for months.
Can Rumination Disorder Be Prevented?
There is no known way to prevent rumination disorder. However, careful attention to a child's eating habits may help catch the disorder before serious complications can occur.