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.

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.

Medication

Absah I, Rishi A, Talley NJ, Katzka D, Halland M. Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterol Motil. 2017 Apr. 29 (4):[QxMD MEDLINE Link].
American Psychiatric Association. Rumination. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). 2013. 332-333.
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. [QxMD MEDLINE Link].
Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, et al. Functional gastroduodenal disorders. Gastroenterology. 2006 Apr. 130(5):1466-79. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Halland M, Pandolfino J, Barba E. Diagnosis and Treatment of Rumination Syndrome. Clin Gastroenterol Hepatol. 2018 Oct. 16 (10):1549-1555. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Chitkara DK, Van Tilburg M, Whitehead WE, Talley NJ. Teaching diaphragmatic breathing for rumination syndrome. Am J Gastroenterol. 2006 Nov. 101(11):2449-52. [QxMD MEDLINE Link].
Chial HJ, Camilleri M, Williams DE, et al. Rumination syndrome in children and adolescents: diagnosis, treatment, andprognosis. Pediatrics. 2003 Jan. 111(1):158-62. [QxMD MEDLINE Link].
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. 1998 Mar. 29(1):31-40. [QxMD MEDLINE Link].
Kuhn DE, Matson JL. Assessment of feeding and mealtime behavior problems in persons with mental retardation. Behav Modif. 2004 Sep. 28(5):638-48. [QxMD MEDLINE Link].
Malcolm A, Thumshirn MB, Camilleri M, Williams DE. Rumination syndrome. Mayo Clin Proc. 1997 Jul. 72(7):646-52. [QxMD MEDLINE Link].
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. 1998 Nov. 27(5):596-8. [QxMD MEDLINE Link].