Rumination disorder most often starts after age 3 months, following a period of normal digestion. It occurs in infants and is rare in children and teenagers. The cause is often unknown. Certain problems, such as lack of stimulation of the infant, neglect, and high-stress family situations have been linked with the disorder.

Rumination disorder may also occur in adults.

Symptoms include:

• Repeatedly bringing up (regurgitating) food. This is effortless and is different from vomiting.
• The food that comes up is usually undigested.
• Repeatedly rechewing food

Symptoms must go on for at least 1 month to fit the definition of rumination disorder.

People do not appear to be upset, retching, or disgusted when they bring up food. It may appear to cause pleasure.

The health care provider must first check for physical causes, such as hiatal hernia, pyloric stenosis, and gastrointestinal system abnormalities that are present from birth (congenital). These conditions can be mistaken for rumination disorder. This may require certain tests.

Rumination disorder can be diagnosed with a test called high resolution manometry with impedance testing. This test is sometimes needed.

Rumination disorder can rarely cause malnutrition. The following lab tests can measure how severe the malnutrition is and determine what nutrients need to be increased:

• Blood test for anemia
• Endocrine hormone functions
• Serum electrolytes
• Serum protein levels
• Serum vitamin levels

Rumination disorder is treated with behavioral techniques. One treatment associates bad consequences with rumination and good consequences with more appropriate behavior (mild aversive training).

Other techniques include improving the environment (if there is abuse or neglect) and counseling the parents.

Diaphragmatic breathing exercises can help rumination.

In some cases, rumination disorder will disappear on its own, and the child will go back to eating normally without treatment. In other cases, treatment is needed.

Complications may include:

• Failure to thrive
• Lowered resistance to disease
• Malnutrition

Contact your provider if your baby appears to be repeatedly spitting up, vomiting, or rechewing food.

There is no known prevention. However, normal stimulation and healthy parent-child relationships may help reduce the odds of rumination disorder.

Katzman DK, Norris ML. Feeding and eating disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/ Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 9.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Rumination and pica. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 36.

Mokha J. Vomiting and nausea. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 8.

Updated by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.