Many parents will attest to having experienced or currently experiencing feeding problems with a child. Feeding and eating disorders are actually more common than we think and can affect a child at any point in development, in this series I will only discuss the ones that affect children in early childhood.

Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.

What is Rumination Disorder?

Have you ever had a child or know of a child that will almost bring back food at almost every feeding? This act has long been known to occur in infants who vomit milk after feeds, but there is however a major difference between reflux and rumination and a medical checkup will clarify what your child is suffering from.

Rumination disorder is a condition in which an individual repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, re-chew it, and then either re-swallow it or spit it out. Because the food hasn’t yet been digested, it reportedly tastes normal and isn’t acidic, as vomit especially in reflux. Rumination typically happens at every meal, soon after eating unlike reflux.

Onset of rumination disorder can occur in infancy, childhood, adolescence, or even adulthood. The age at onset in infants is usually between ages 3 months and 12 months. In infancy and early childhood the disorder can be so severe that it can result in medical emergencies for severe malnutrition and not meeting developmental milestones. It can potentially be fatal, particularly in infancy. Rumination disorder can have an episodic course or occur continuously until treated

What is the Difference between Rumination Disorder & Reflux?

Symptoms of rumination disorder are different from those for acid reflux and GERD:

•  In acid reflux, acid used to break down food in the stomach rises into the esophagus. That may cause a burning sensation in the chest and a sour taste in the throat or mouth.
•  In acid reflux, food is occasionally regurgitated, but it tastes sour or bitter, which is not the case with regurgitated food in rumination
•  Acid reflux more often occurs at night or when lying down because it easier for the contents of the stomach to rise up the esophagus.
   Rumination disorder occurs shortly after the ingestion of food.
   Symptoms of rumination disorder don’t respond to treatments for acid reflux and GERD.disorder.

How is Rumination Disorder Diagnosed?

There is no specific testing for rumination disorder and so the diagnosis can be a joined effort of professionals from psychologists to medical doctors because the child’s current symptoms will need to be observed, a medical history is also needed and sometimes some medical tests will need to be performed. In most cases an observation of the behavior is often enough to diagnose rumination disorder. The most common medical testing for this disorder is done to see whether there is increased pressure in the abdomen which can be what is causing the food to travel back upwards. For a diagnosis of Rumination Disorder to be given the following criteria has to be fulfilled: A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux). C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability [Intellectual developmental disorder] or another neuro developmental disorder), they are sufficiently severe to warrant additional clinical attention. The essential feature of rumination disorder is the repeated regurgitation of food occurring after feeding or eating over a period of at least one month. Previously swallowed food that may be partially digested is brought up into the mouth without apparent nausea, involuntary retching, or disgust. Regurgitation in rumination disorder should be frequent, occurring at least several times per week, typically daily.

What Are the Signs & Symptoms of Rumination Disorder?

Signs and symptoms of rumination disorder are the same in both children and adults however adults are more likely to spit out regurgitated food and children are more likely to re-chew and re-swallow the food. The most common signs and symptoms to look out for are as follows:

•  Effortless regurgitation, typically between ten to thirty minutes after a meal.
•  Abdominal pain or pressure relieved by regurgitation
•  A feeling of fullness
•  Bad breath
•  Weight loss or being under-weight from the developmentally expected range.

•  Psychosocial problems such as lack of stimulation, neglect, stressful life situations, and problems in the parent-child relationship may be predisposing factors in infants and young children.
•  Having an acute or chronic illness can contribute to a child developing Rumination Disorder.
•  Having a mental disorder.
•  Experiencing a psychiatric disturbance.
•  Undergoing major surgery. Complications:

What Causes Rumination Disorder?

It is not clear what causes rumination disorder but from medical tests done on patients, it appears to be caused by an increase in abdominal pressure.
Rumination syndrome is frequently confused with other eating disorders like gastroesophageal reflux disease (GERD) and gastroparesis. Some people have rumination disorder linked to a rectal evacuation disorder, in which poor coordination of pelvic floor muscles leads to chronic constipation and pressure in the gut pushes food upwards. Risk Factors & complications of Rumination Disorder Risk Factors:

•  Unhealthy weight loss – Weight loss and failure to make expected weight gains are common features in infants with rumination disorder.
•  Malnutrition – Malnutrition may occur despite the infant’s apparent hunger and the ingestion of relatively large amounts of food, particularly in severe cases, when regurgitation immediately follows each feeding episode and regurgitated food is expelled. Malnutrition might also occur in older children and adults, particularly when the regurgitation is accompanied by restriction of food intake. Rumination may be associated with growth delay and have a negative effect on development and learning potential.
•  Dental erosion.
•  Irritability in younger children – They may be irritable and hungry between episodes of regurgitation.
•  Bad breath.
•  Raw and chapped lips.
•  Embarrassment in older children which might lead to food intake avoidance.

•  Social isolation in older children – fear of going into social spaces in an attempt to hide their disorder from peers as it may attract bullying.
•  Repeated stomachaches and indigestion.
•  Choking hazard in younger children.
•  If left untreated, rumination disorder can damage the esophagus.
•  Poor nutrition in an attempt to avoid certain foods that bring about regurgitation.
•  Electrolyte imbalance.
•  Dehydration.
•  Aspiration (inhalation of food into the airway [trachea/lungs])
•  Pneumonia

Treatment & Prevention

The most common treatment or treatment of choice for Rumination Disorder is behavioral therapy that involves teaching people to breathe from the diaphragm. The main reason for this treatment being that for most of the cases there isn’t a physical etiology, so behavioral therapy is employed to train individuals how to stop regurgitation. The behavioral therapy intervention that is usually prescribed for rumination disorder is diaphragmatic breathing.

The diaphragm is a large, dome-shaped muscle located at the base of the lungs. Diaphragmatic breathing is intended to help you relax the diaphragm and use it correctly while breathing to strengthen it and in the process one is actively able to release abdominal pressure.

If there are any physiological issues that are causing or contributing to Rumination Disorder a medical doctor will treat or advise accordingly.

And because the actual cause of this disorder is not known and the onset is very early (three months of age), it is difficult to prevent it from happening. However, early intervention for treatment or management has proven very effective.

Talent Adamson Behaviour Therapist

BA (Health and Social Services) Applied Psychology, BA Hon (HSS) Psychological Counselling – (UNISA)