Rumination Treatment & Management

Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD more...

Updated: Mar 29, 2012

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Medical Care
Surgical Care
Consultations
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Medical Care

Correct caloric insufficiency/deprivation.
Provide appropriate medical treatment for recurrent bronchitis or pneumonia.
Reflex laryngospasm, bronchospasm, and asthma (associated with repeated pulmonary aspiration of gastric fluid) may require appropriate medical treatment.

Surgical Care

Gastroesophageal fundoplication has been used as an antireflux surgical intervention in cases with a clear physiological etiology and when the rumination has not responded to less invasive interventions.

Behavioral: Conduct a functional assessment to determine if rumination serves as self-stimulation or is socially motivated. Functional analysis can be used to compare the efficacy of various treatment strategies.^[6]Self-stimulation is often associated with reconsumption of ruminate; however, little or no reconsumption of ruminate is associated with socially motivated rumination. Rumination may begin as self-stimulation but becomes reinforced because of the attention it attracts.
- Nonaversive behavioral strategies include the following:
  - Food satiation (eg, unlimited quantities of thick food)
  - Small bites of normal amounts of food over an extended eating time, if self-stimulation is identified
  - Reinforcement of incompatible behaviors
  - Reinforcement of other behaviors
  - Special feeding techniques
  - Contingent exercise (eg, defined physical activity required upon ruminating)
  - Habit reversal with relaxation
  - Diaphragmatic breathing^[7]
  - Self-hypnosis with relaxation
  - Guided imagery
  - Biofeedback with abdominal relaxation
  - Complete chewing
  - Relaxation while eating
  - Weight reduction
  - Stress management
  - Throat clearing
  - Sipping water between bites
  - Decreasing caffeine and alcohol consumption
- Aversive behavioral strategies are recommended if the individual's health is jeopardized or if the individual's health status has had a rapid and dramatic change. Aversive strategies include the following:
  - Electroshock therapy
  - Overcorrection
  - Withdrawal of positive reinforcement (ie, extinction)
  - Contingent pinching (ie, individual is pinched upon ruminating)
  - Noxious tastes
Psychodynamic
- Provide noncontingent holding for individuals who are young and institutionalized.
- Address psychological distress, depression, and anxiety.

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Contributor Information and Disclosures

Author

Cynthia R Ellis, MD Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Connie J Schnoes, MA, PhD Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town

Disclosure: Nothing to disclose.

Specialty Editor Board

Angelo P Giardino, MD, PhD, MPH Associate Professor, Baylor College of Medicine; Chief Medical Officer, Texas Children's Health Plan; Chief Quality Officer, Medicine, Texas Children's Hospital

Angelo P Giardino, MD, PhD, MPH is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

American Psychiatric Association. Rumination. Diagnostic and Statistical Manual of Mental Disorders (4th Ed.-TR). 2000;105-106.
Idaira Y, Nomura Y, Tamaki Y, Katsumura S, Kodama S, Kurata K, et al. Factors affecting the oral condition of patients with severe motor and intellectual disabilities. Oral Dis. Jul 2008;14(5):435-9. [Medline].
Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, et al. Functional gastroduodenal disorders. Gastroenterology. Apr 2006;130(5):1466-79. [Medline].
Green AD, Alioto A, Mousa H, Di Lorenzo C. Severe pediatric rumination syndrome: successful interdisciplinary inpatient management. J Pediatr Gastroenterol Nutr. Apr 2011;52(4):414-8. [Medline].
Kessing BF, Govaert F, Masclee AA, Conchillo JM. Impedance measurements and high-resolution manometry help to better define rumination episodes. Scand J Gastroenterol. Nov 2011;46(11):1310-5. [Medline].
Lyons EA, Rue HC, Luiselli JK, DiGennaro FD. Brief functional analysis and supplemental feeding for postmeal rumination in children with developmental disabilities. J Appl Behav Anal. Winter 2007;40(4):743-7. [Medline].
Chitkara DK, Van Tilburg M, Whitehead WE, Talley NJ. Teaching diaphragmatic breathing for rumination syndrome. Am J Gastroenterol. Nov 2006;101(11):2449-52. [Medline].
Chial HJ, Camilleri M, Williams DE, et al. Rumination syndrome in children and adolescents: diagnosis, treatment, andprognosis. Pediatrics. Jan 2003;111(1):158-62. [Medline].
Ellis CR, Parr TS, Singh NN. Rumination Prevention and Treatment of Severe Behavior Problems: Models and Methods. Dev. 1997;237-52.
Fredericks DW, Carr JE, Williams WL. Overview of the treatment of rumination disorder for adults in a residential setting. J Behav Ther Exp Psychiatry. Mar 1998;29(1):31-40. [Medline].
Kuhn DE, Matson JL. Assessment of feeding and mealtime behavior problems in persons with mental retardation. Behav Modif. Sep 2004;28(5):638-48. [Medline].
Malcolm A, Thumshirn MB, Camilleri M, Williams DE. Rumination syndrome. Mayo Clin Proc. Jul 1997;72(7):646-52. [Medline].
Singh NN. Rumination. International Review of Research in Mental Retardation. 1981;10:139-82.
Wagaman JR, Williams DE, Camilleri M. Behavioral intervention for the treatment of rumination. J Pediatr Gastroenterol Nutr. Nov 1998;27(5):596-8. [Medline].

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Rumination Treatment & Management

Medical Care

Surgical Care

Consultations