Rumination Disorder

Rumination Disorder is a feeding and eating disorder characterized by repeated regurgitation of food occurring after feeding or eating over a period of at least one month.

• The prevalence is not well understood, but is most common in those with intellectual disability.
• The disorder may be diagnosed across the life span.^[1]
• The age at onset in infants is usually between ages 3 to 12 months.^[2]
• It may be more common in males.

• In infants, the disorder frequently remits spontaneously
  • However the course can be protracted in some cases, and can even result in medical emergencies (e.g. - severe malnutrition).^[3]
• In older children, adolescents, and adults, social functioning is likely to be adversely affected.^[4]

• Infants and older individuals with intellectual disability or other neurodevelopmental disorders are more likely to have rumination.
  • The regurgitation and rumination behaviour appears to have a self-soothing or self-stimulating function (similar to repetitive motor behaviours such as head banging).^[5]

• Psychosocial factors such as low stimulation, neglect, life stressors, and difficulties in the parent-child relationship may increase the risk in infants and young children.^[6]

Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g. - gastroesophageal reflux, pyloric stenosis).

The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

If the symptoms occur in the context of another mental disorder (e.g. - intellectual developmental disorder or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.

• Infants with rumination disorder display a classic position of straining and arching the back with the head held back, making sucking movements with their tongue. They may give the impression of gaining satisfaction from the activity, but will be irritable and hungry between episodes of regurgitation.^[7]
  • Weight loss is a common feature, and malnutrition may occur despite the infant's apparent hunger and the ingestion of relatively large amounts of food.^[8]
• Children and adults with rumination can also have malnutrition, especially when the regurgitation is accompanied by restriction of intake. The behaviours may be disguised by placing a hand over the mouth or coughing. Some may avoid eating with others because they are aware of the social undesirability of their behaviours (e.g. - avoiding breakfast because it may be followed by regurgitation).^[9]
  • Individuals may describe the behaviour as being habitual or outside of their control.^[10]

• Gastrointestinal conditions
  • It is important to differentiate regurgitation in rumination disorder from other conditions characterized by gastroesophageal reflux (GERD) or vomiting. Conditions such as pyloric stenosis, hiatal hernia, gastroparesis, and Sandifer syndrome should be ruled out by appropriate physical examinations, investigations, and laboratory tests.
• Anorexia nervosa and bulimia nervosa
  • Individuals with these other eating disorders may also regurgitated as a means of disposing of ingested calories because of concerns about weight gain.

• As per the differential diagnosis, more detailed gastrointestinal investigations may be required.

• As per the differential diagnosis, more detailed gastrointestinal investigations may be required.

• Behavioural therapy and diaphragmatic breathing have been recommended.^[11]
• There may be some evidence for the use of metoclopramide, cimetidine, and haloperidol.^[12]