Rumination disorder

Causes

Rumination disorder usually starts after age 3 months, following a period of normal digestion. It occurs in infants and is rare in children and teenagers. The cause is often unknown. Certain problems, such as lack of stimulation of the infant, neglect, and high-stress family situations, have been associated with the disorder.

Rumination disorder may also occur in adults.

Symptoms

• Repeatedly bringing up (regurgitating) food
• Repeatedly rechewing food

Symptoms must go on for at least 1 month to fit the definition of rumination disorder.

People do not appear to be upset, retching, or disgusted when they bring up food. It may appear to cause pleasure.

Exams and Tests

The health care provider must first rule out physical causes, such as hiatal hernia, pyloric stenosis, and gastrointestinal system abnormalities that are present from birth (congenital). These conditions can be mistaken for rumination disorder.

Rumination disorder can cause malnutrition. The following lab tests can measure how severe the malnutrition is and determine what nutrients need to be increased:

• Blood test for anemia
• Endocrine - hormone functions
• Serum electrolytes

Treatment

Rumination disorder is treated with behavioral techniques. One treatment associates bad consequences with rumination and good consequences with more appropriate behavior (mild aversive training).

Other techniques include improving the environment (if there is abuse or neglect) and counseling the parents.

Outlook (Prognosis)

In some cases rumination disorder will disappear on its own, and the child will go back to eating normally without treatment. In other cases, treatment is necessary.

Possible Complications

• Failure to thrive
• Lowered resistance to disease
• Malnutrition

When to Contact a Medical Professional

Call your health care provider if your baby appears to be repeatedly spitting up, vomiting, or rechewing food.

Prevention

There is no known prevention. However, normal stimulation and healthy parent-child relationships may help reduce the odds of rumination disorder.

References

Katz ER, DeMaso DR. Rumination disorder. In: Kliegman RM, Behrman RE, Stanton BF, St. Geme JW III, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.1.

Update Date: 2/18/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.