Rumination Disorder
A feeding disorder characterized by the repeated regurgitation of food for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. The behavior is not due to a medical condition and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
Prevalence: Rare in general population. More common in infants and young children, individuals with intellectual disabilities, and psychiatric populations. Prevalence in these higher-risk groups may be 6-10%.
Common Symptoms
- Repeated regurgitation of food after eating
- Regurgitated food may be re-chewed, re-swallowed, or spit out
- Appears effortless and not preceded by nausea or retching
- Not accompanied by disgust or distress (in some cases)
- Symptoms present for at least 1 month
- Symptom onset after period of normal functioning
- Weight loss or failure to gain expected weight (in children)
- Malnutrition possible in severe cases
- Dental problems (enamel erosion from stomach acid)
- Bad breath (halitosis)
- Social embarrassment or isolation due to behavior
- Abdominal pain or discomfort
- Chapped or cracked lips
- In infants: arching back during feeding, irritability
- Behavior may be more likely to occur when alone or unstimulated
Risk Factors
- Intellectual disability (significantly increased risk)
- Autism spectrum disorder
- Anxiety disorders
- Neglect or inadequate stimulation in infancy
- Previous gastrointestinal problems or reflux (even if resolved)
- Developmental delays
- Living in institutional settings
- Limited social interaction or environmental stimulation
- History of early feeding difficulties
Treatment Approaches
- Behavioral therapy - First-line treatment
- Habit reversal training (awareness training + competing response)
- Diaphragmatic breathing training during/after meals
- Positive reinforcement for periods without rumination
- For infants: increased social interaction and stimulation during feeding
- Cognitive Behavioral Therapy (CBT) for older children/adults
- Address underlying anxiety or stress with therapy
- Biofeedback training
- Family therapy and parent training
- Occupational therapy for alternative sensory strategies
- Nutritional rehabilitation if malnourished
- Dental care for oral health complications
- Treat any underlying gastrointestinal conditions
- Medications: typically not first-line, but may use:
- - Proton pump inhibitors if GERD present
- - SSRIs for comorbid anxiety/OCD
- Multidisciplinary approach (behavioral health + nutrition + medical)
Self-Help & Natural Approaches
- Diaphragmatic breathing exercises during and after meals
- Distraction techniques during high-risk times (after eating)
- Engaging in activities immediately after eating
- Habit reversal training (awareness and competing response)
- Stress reduction and relaxation techniques
- For infants: increased stimulation and interaction during feeding
- Upright positioning during and after meals
- Eating in social settings rather than alone
- Mindful eating practices
- Self-monitoring to identify triggers and patterns
- Pleasant activities scheduled after meals
- Social support and peer interactions
- Oral sensory activities (chewing gum, hard candy) as substitute
- Environmental enrichment (engaging hobbies, activities)
- Regular dental care to address oral health
- Adequate hydration
- Small, frequent meals rather than large meals
When to Seek Professional Help
- Regurgitation behavior persists for more than 1 month
- Weight loss or failure to gain weight (especially in children)
- Malnutrition or nutritional deficiencies
- Dental problems (enamel erosion, cavities)
- Social isolation or embarrassment affecting quality of life
- Behavior interferes with school, work, or activities
- Family distress about the behavior
- Symptoms worsen or don't improve with initial strategies
- Infant showing signs of distress or failure to thrive
- Co-occurring mental health concerns (anxiety, depression)
Crisis Resources
- 988 Suicide & Crisis Lifeline: Call or text 988
- SAMHSA National Helpline: 1-800-662-4357
- National Eating Disorders Association (NEDA) Helpline: 1-800-931-2237
- Crisis Text Line: Text HELLO to 741741
- National Alliance on Mental Illness (NAMI): 1-800-950-6264
- Academy for Eating Disorders: aedweb.org
- Pediatrician or primary care provider for infants/children
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.