Rumination disorder

What it is

Rumination disorder is the repeated, effortless return of recently swallowed food into the mouth, where it is re-chewed, re-swallowed or spat out, occurring for at least a month. There is no retching and usually no nausea; it often happens within minutes of eating, meal after meal. It occurs in infants, in people with developmental disabilities, and in otherwise healthy children, adolescents and adults, where it is frequently mistaken for reflux or vomiting for years.

The mechanism is an unconscious habit: a learned contraction of the abdominal wall that pushes food back up. Because it is a habit of muscles, it can be untrained.

What helps

Diagnosis first: a clinician (often a gastroenterologist working with a psychologist) distinguishes rumination from reflux disease and other conditions by the story and timing; invasive tests are not always needed. The core treatment is diaphragmatic breathing retraining: slow belly-breathing practised during and after meals physically competes with the muscular habit and, done consistently, extinguishes it in most people. In infants, the focus is on attention, feeding interaction and reducing under-stimulation. Outcomes are good, which makes the years of misdiagnosis the real tragedy of this condition.

Rumination disorder in the African context

Rumination disorder, the repeated bringing back up of food that is then re-chewed, re-swallowed, or spat out, is little known here and easily mistaken for ordinary vomiting, a digestive disease, or simply a bad habit. It is important first to rule out medical causes, which a doctor should check. Where it is rumination disorder, it is often a behaviour that has become automatic, sometimes a self-soothing pattern, and it is most common in infants and in people with intellectual disability, though it occurs in others too. It can affect nutrition and growth and carries social embarrassment. Recognising it, ruling out medical causes, and using calm behavioural approaches rather than punishment, is what helps.

Helping someone

A calm, non-punitive, practical approach works best.

• First seek medical assessment to rule out physical causes of bringing food back up.
• Avoid punishment or shaming, which does not help and adds distress.
• For infants, extra holding, comfort, and calm feeding can reduce it; for others, behavioural approaches taught by a clinician help.
• Watch nutrition and growth, and seek help if weight or health is affected.
• Seek specialist support, especially where intellectual disability is involved. Our find a therapist page can help.