Rumination Treatment & Management

Updated: Oct 01, 2019
  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD  more...
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Approach Considerations

Diaphragmatic breathing with or without biofeedback is the first-line therapy in all cases of rumination syndrome. [6]


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.


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.




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. [8] 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 [9, 1]

  • 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


Provide noncontingent holding for individuals who are young and institutionalized.

Address psychological distress, depression, and anxiety.