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What is Rumination Disorder in Children?
One eating disorder that is not heard of very often is rumination disorder in children. While it can be found in children and adults of normal intelligence, rumination disorder is usually found in infants and those who are developmentally disabled.
This disorder is diagnosed when someone brings food back up deliberately through the throat and mouth and will either rechew and reswallow or will spit the food out. This process seems to be an effortless regurgitation for those with this disorder. Typically, they do not have nausea, abdominal pain, or heartburn when this occurs.
When this behavior occurs in infants, it is often assumed that it is normal infant vomiting and is usually overlooked.
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While there are theories relating to the possible causes of rumination disorder, there is no generally agreed upon consensus.
It is thought by some that a lack of early nurturing or need of physical contact may be at the root of this disorder. The theory is that the rumination may be an attempt to soothe themselves with this behavior. There is also the possibility that biological factors may be involved.
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Symptoms associated with this disorder are malnutrition and weight loss, halitosis, electrolyte inconsistencies, and, in older children or adults, dental erosion.
Because of the digestive issues that are related to rumination disorder, constipation and/or diarrhea are common. Bloating, nausea, and some abdominal pain may also develop in some children over time.
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Because of the diversity of ages involved with this disorder, treatments may differ greatly. Pediatricians, psychologists, and gastroenterologists may have to collaborate with parents, family members, and teachers to give the children the best chance of a successful outcome.
Depending on the age of the child, medicines may be beneficial in treating ruminating behaviors. H2 blockers, proton pump inhibitors, and prokinetic medications may singly or collectively be prescribed for treatment.
Medications are usually only prescribed to assist in protecting the esophagus lining until a form of behavioral therapy starts to reduce severity and frequency of ruminating or regurgitation behavior.
Therapies such as relaxation training, biofeedback, cognitive behavioral therapy, and diaphragmatic breathing may be used as measures to assist in reducing or removing rumination behaviors in children.
When the patient is an infant, more physical contact between a caregiver and the infant is encouraged. An attempt is made to make feeding time a more enjoyable experience. Trying to distract the child when ruminating behavior is suspected may also help reduce the frequency of the behaviors.
A behavioral therapy called habit reversal has been found to be very successful with rumination disorder patients of normal intelligence. Patients are taught to record when they bring food back up and then are taught a breathing method called diaphragmatic breathing when they ruminate. Diaphragmatic breathing involves breathing in and out using the abdominal muscles while making the effort to keep the chest immobile or motionless. This exercise helps to prevent abdominal contractions which in turn helps to prevent regurgitation.
In developmentally disabled patients, behavioral techniques such as a mild form of aversive training may be used to treat this disorder. Aversive training is a behavioral technique that would associate rumination with a negative consequence.
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While there is no known method of preventing rumination disorder in children, it is thought that a strengthening of the parent/child bond may prevent the chance of a rumination disorder occurring in the child.
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American Academy of Pediatrics - Rumination Syndrome in Children and Adolescents: Diagnosis, Treatment, and Prognosis: http://pediatrics.aappublications.org/cgi/content/full/111/1/158
Mayo Clinic - Rumination Syndrome: http://www.mayoclinic.org/rumination-syndrome/