Rumination Disorder

Rumination syndrome, also known as rumination disorder, is the repeated regurgitation and rechewing of food. It is commonly seen in infants and is frequently accompanied by rhythmic movements and relaxation. Other self-soothing behaviors are often observed in children with rumination disorder, such as thumb sucking, head banging, and body rocking. Symptoms include:

• Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning.

• The behavior is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).

• The behavior does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. If the symptoms occur exclusively during the course of mental retardation or a pervasive developmental disorder, they are sufficiently severe to warrant independent clinical attention.

Etiomology

Both environmental and biological causes have been suggested. Frequently inadequacy of the parent–child relationship is cited as a cause of rumination disorder, forcing the child to seek gratification internally; however, no clear evidence to support this theory exists. Predisposing factors for rumination disorder may also include other psychosocial stressors such as lack of stimulation or neglect. Exploration of the relationship between rumination disorder and gastroesophageal reflux may prove fruitful. Genetic factors in the disorder are unknown.

Course

Typically appearing between the ages of 3 and 12 months, rumination disorder frequently spontaneously remits by age 3 years. Individuals with intellectual disability frequently demonstrate longer duration or chronicity. Risks associated with the disorder include aspiration and malnutrition. A major complication is the parental reaction to the symptoms, including anxiety, frustration, distress, and disgust, all of which may contribute to disrupted attachment and understimulation of the child.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.