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Rumination Treatment & Management

  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Feb 17, 2015
 

Medical Care

See the list below:

  • 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.
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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.

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Consultations

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 Director, National Behavioral Health Dissemination, Supervising Practitioner, Boys Town Center for Behavioral Health, Father Flanagan’s Boys’ Home, Boys Town

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Angelo P Giardino, MD, MPH, PhD Professor and Section Head, Academic General Pediatrics, Baylor College of Medicine; Senior Vice President and Chief Quality Officer, Texas Children’s Hospital

Angelo P Giardino, MD, MPH, PhD 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, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Received grant/research funds from Health Resources and Services Administration (HRSA) Integrated Community Systems for CSHCN Grant for other; Received advisory board from Baxter Healthcare Corporation for board membership.

References
  1. American Psychiatric Association. Rumination. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). 2013. 332-333.

  2. 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. 2008 Jul. 14(5):435-9. [Medline].

  3. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, et al. Functional gastroduodenal disorders. Gastroenterology. 2006 Apr. 130(5):1466-79. [Medline].

  4. Green AD, Alioto A, Mousa H, Di Lorenzo C. Severe pediatric rumination syndrome: successful interdisciplinary inpatient management. J Pediatr Gastroenterol Nutr. 2011 Apr. 52(4):414-8. [Medline].

  5. Kessing BF, Govaert F, Masclee AA, Conchillo JM. Impedance measurements and high-resolution manometry help to better define rumination episodes. Scand J Gastroenterol. 2011 Nov. 46(11):1310-5. [Medline].

  6. 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. 2007 Winter. 40(4):743-7. [Medline].

  7. Chitkara DK, Van Tilburg M, Whitehead WE, Talley NJ. Teaching diaphragmatic breathing for rumination syndrome. Am J Gastroenterol. 2006 Nov. 101(11):2449-52. [Medline].

  8. American Psychiatric Association. Rumination. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed-TR. APA; 105-106.

  9. Chial HJ, Camilleri M, Williams DE, et al. Rumination syndrome in children and adolescents: diagnosis, treatment, andprognosis. Pediatrics. 2003 Jan. 111(1):158-62. [Medline].

  10. Ellis CR, Parr TS, Singh NN. Rumination Prevention and Treatment of Severe Behavior Problems: Models and Methods. Dev. 1997. 237-52.

  11. Fredericks DW, Carr JE, Williams WL. Overview of the treatment of rumination disorder for adults in a residential setting. J Behav Ther Exp Psychiatry. 1998 Mar. 29(1):31-40. [Medline].

  12. Kuhn DE, Matson JL. Assessment of feeding and mealtime behavior problems in persons with mental retardation. Behav Modif. 2004 Sep. 28(5):638-48. [Medline].

  13. Malcolm A, Thumshirn MB, Camilleri M, Williams DE. Rumination syndrome. Mayo Clin Proc. 1997 Jul. 72(7):646-52. [Medline].

  14. Singh NN. Rumination. International Review of Research in Mental Retardation. 1981. 10:139-82.

  15. Wagaman JR, Williams DE, Camilleri M. Behavioral intervention for the treatment of rumination. J Pediatr Gastroenterol Nutr. 1998 Nov. 27(5):596-8. [Medline].

 
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