Rumination Treatment & Management

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

Approach Considerations

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

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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. [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

Psychodynamic

Provide noncontingent holding for individuals who are young and institutionalized.

Address psychological distress, depression, and anxiety.

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