Children's Health and Wellness

Rumination Syndrome

Rumination syndrome, or Merycism, is a rare disorder that affects children and some adults. If your child has this condition, he or she will usually eat meals normally. But after about an hour or two, undigested food comes back up into his or her mouth from the esophagus. Your child will either rechew and reswallow the food, or spit it out. Typically this happens at every meal, day after day. Rumination is a reflex, not a conscious decision.

Facts about rumination syndrome

The word rumination comes from cows, or other animals that regurgitate food as part of their normal digestive process. Rumination syndrome used to be considered a rare disorder. It seemed to primarily affect children with mental disabilities. Health care providers now realize that the condition may be more common.

Although still rare, rumination is now being diagnosed in both children and adults. Researchers speculate this may be happening because health care providers are now able to recognize and diagnose rumination syndrome more frequently than in the past. Rumination is not actually occurring more often.

What are the symptoms?

Rumination is different from vomiting. With rumination, the food is undigested and often still tastes the same as when it was first eaten. Researchers believe that rumination is unconscious. However, they also believe that the voluntary muscle relaxation of the diaphragm becomes a learned habit. It may be a variation of the typical belching reflex–instead of burping up gas, the reflex causes actual food to come back up.

How is it diagnosed?

Since vomiting is much more common, rumination syndrome is often misdiagnosed as a vomiting disorder, such as gastroparesis or gastroesophageal reflux disease.

In order to diagnose rumination syndrome properly, health care providers need to ask the right questions. For instance, asking what the food tastes like when it comes up is important. If it still tastes good, this means the food is undigested, making rumination syndrome a good possibility. Vomited food has been digested and typically is not kept in the mouth.

How is it treated?

No drugs are available to effectively treat rumination syndrome. Recent research suggests that the best way to stop rumination syndrome is to relearn how to eat and digest food properly. This requires diaphragmatic rebreathing training.

A behavioral psychologist usually teaches this, and it's easy to learn. The technique has to be used at the start of every meal to avoid regurgitation. Over time, most people can master the breathing technique and eliminate the unpleasant symptoms of rumination syndrome.

Can it be prevented?

Experts aren't sure why rumination syndrome starts in the first place, so it's unclear what can be done to prevent it. But the diaphragmatic rebreathing training is effective at stopping it.

Managing rumination syndrome

The good news about rumination syndrome is that it doesn't seem to do much physical damage. In rare instances, it can cause problems with the esophagus. In some adolescents, it has caused a small amount of weight loss.

Work with your, or your child's, health care provider to recognize the symptoms. Then, work with a behavioral psychologist to end the pattern. 

Online Source: UpToDate: Etiology and Diagnosis of Delayed Gastric Emptyinghttp://www.uptodate.com/contents/gastroparesis-etiology-clinical-manifestations-and-diagnosis
Author: McCoy, Krisha
Online Editor: Kochman, Marilyn
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Online Medical Reviewer: Roux, Susan L., ARNP
Date Last Reviewed: 9/1/2013
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