Rumination Syndrome

Also called: Merycism, Rumination Disorder

What Is Rumination Syndrome?

Rumination syndrome happens when just-swallowed food comes back up into the mouth from the stomach. When this happens, a person chews and swallows the food again or spits it out. Rumination syndrome isn’t the same as vomiting (throwing up), which is when fully digested food comes back up. The condition seems to be a reflex — kids don’t do it on purpose — but it can start after an illness that causes vomiting.

Most young children with rumination syndrome outgrow it. In kids ages 10 and older, though, the condition can last longer and be tougher to manage.

What Are the Signs & Symptoms of Rumination Syndrome?

Rumination syndrome may cause these signs and symptoms:

• just-swallowed food comes back up into the mouth and doesn’t taste bitter or sour (like vomit)
• feeling full or having nausea (feeling sick to the stomach)
• upset stomach or belly pain
• weight loss
• chapped lips
• bad breath

When food comes back up in babies, they may tighten their belly, arch their back, look like they’re sucking, or put their head back.

What Problems Can Happen?

Rumination syndrome can lead to problems from poor nutrition. Kids may not get enough vitamins, minerals, and protein. They may not grow well or could become dehydrated (have too little water in the body).

When food comes back up, it can also cause choking or breathing problems like pneumonia if food particles are inhaled into the lungs by accident.

Some kids with rumination disorder may feel stressed because of it. They may have trouble doing their normal routines and activities, like school or sports.

What Causes Rumination Syndrome?

Doctors don’t know exactly what causes rumination syndrome. It could be due to problems with how the digestive system and brain “talk” to each other.

Rumination syndrome seems to be a reflex, meaning that the child doesn’t bring food or fluids back up on purpose. The condition usually starts or is triggered by something that causes a child to throw up, like a virus. When kids have a stomach virus or throw up because of an illness, they’re often uncomfortable. This causes anxiety about throwing up again, which can cause even more stomach sensitivity. The belly tightens and food and drink go back up into the mouth.

Doctors also think that rumination syndrome develops in some kids as a source of comfort. Rechewing food may make them feel better if they’re feeling worried or stressed.

Rumination syndrome most often affects babies as well as children who have developmental delays. It also can happen in kids who have long-term constipation problems, and those with depression, anxiety, or another mental health problem. Kids of any age can have the condition.

How Is Rumination Syndrome Diagnosed?

To diagnose rumination syndrome, doctors will ask about symptoms and do an exam. They may do blood tests, X-rays, or tests that look at the digestive system. Doctors may also ask about any stressors at home or school and watch kids while and after they eat.

How Is Rumination Syndrome Treated?

Treatment for rumination syndrome includes teaching kids the right way to eat food and let it digest. They learn how to notice when their belly gets tight and relax the muscles to help prevent food from coming back up.

Your doctor may suggest seeing a mental health provider, such as a psychologist. They can help your child deal with anxiety or depression and teach behavioral techniques, including:

• Diaphragmatic breathing. Kids learn how to sense when food is going to come back up.
• Exposure therapy. Children gradually face situations that trigger rumination syndrome.

You can help your child practice the techniques at home.

If rumination syndrome causes your child to lose weight or not grow properly, your doctor may suggest diet changes. Sometimes kids need enteral (EN-tur-ul) nutrition therapy, which consists of special drinks with vitamins and other nutrients kids need to grow.

What Else Should I Know?

Rumination syndrome can be mistaken for conditions like gastroesophageal reflux (GER) or bulimia. That’s why having a doctor diagnose it is important. If you have questions about rumination syndrome, talk with your doctor.