Rumination disorder

• Causes, incidence, and risk factors

  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 re-chewing 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.

• Signs and tests

  The health care provider must first rule out physical causes, such as hiatal hernia and pyloric stenosis. 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.

• Expectations (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.

• Complications
  • Failure to thrive
  • Lowered resistance to disease
  • Malnutrition
• Calling your health care provider

  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

  Boris NW, Dalton R. Vegetative disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 22.

Review Date: 1/20/2010

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.