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Functional Rumination Syndrome

Everything a parent needs to know about Rumination Syndrome in children

So, your child has been diagnosed with Rumination Syndrome? This is where you can find out more about this digestive problem. If you have any questions about RS after reading this, please message me - I am happy to help.

What is Rumination Syndrome?

Rumination is a word used to describe the way ruminant animals chew food over and over again before swallowing, only to regurgitate the bolus of food and rechew it. Thus, rumination is the word used to describe the same issue when it occurs during the digestive process in humans.

The definition of Rumination Syndrome is when a bolus of chewed food is swallowed and regurgitated before the digestive process can begin, and chewed repetitively when the food bolus comes back into the mouth. The bolus comes back into the mouth from the stomach, via the oesophagus. This can happen with both food and drink.

Rumination is a spontaneous action, and sometimes your child won’t even be able to predict the regurgitation is going to happen. As a parent, you might not observe the regurgitation happening in your child as it doesn’t resemble vomiting. Your child will simply continue to chew the food bolus and re-swallow it or else spit it out.

Children with rumination syndrome most often experience the need to regurgitate whenever they eat or drink. Some children feel the need to regurgitate after each bite of food, while others require a more significant amount of food to be ingested before the need to regurgitate occurs. 

Rumination Syndrome was thought to be a fairly uncommon digestive disorder in the days when medical records were not studied on a national level, but now that we have access to more data about the disorder we recognise it to be more prevalent than we previously believed. 

What causes rumination syndrome in children?

In medical terms, RS is described as a functional gastrointestinal disorder and, similar to other functional disorders, there is no actual physical abnormality or organic disease present. 

The symptoms occur because of the unique way the child’s brain and digestive system interact. 

Sometimes, there is a triggering incident that sets off the syndrome: a viral infection, a gastrointestinal disease, or some other problem related to the digestive system. However, sometimes a stressful incident can lead to a diagnosis of Rumination Syndrome.

The stressful incident might be minor, such as a change in routine or environment, but it can lead to the child developing an increase of sensitivity in their digestive capabilities and function. When the stomach is stressed and uncomfortable, it leads to ingested food or drink triggering a contraction in the abdominal muscles surrounding the stomach, which results in the bolus of ingested matter to be regurgitated.

Rumination Syndrome only becomes a problem after the triggering event has been resolved, but the regurgitation reflex action is left behind, imprinted in the stomach muscle memory, becoming a habitual action after any ingestion of food or drink.

What are the symptoms of Rumination Syndrome?

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Rumination is completely different from vomiting, especially the kind of spewing forth that we associate with illness in children, such as projectile vomiting. Rumination is a chronic digestive disorder, repeated with every meal. 

The undigested chewed food (still in bolus form, and with no significant amount of stomach acid mixed in), will taste the same and look the same as it did when it was in the mouth. Symptoms associated with Rumination Syndrome can include repetitive burping or belching, except instead of trapped air gases being brought back up the oesophagus, consumed food is brought back up into the mouth. 

Some children will experience pain or discomfort when they have Rumination Syndrome, while others may not. Additionally, some children might have nausea or the sensation that they are about to vomit. 

If you are looking for signs of possible Rumination Syndrome in your child, keep an eye out for a change in diet preferences. If a kid starts to avoid certain foods or drinks, or lowers the amount of food they consume at mealtimes, this could indicate RS as the child might be trying to limit RS symptoms with these actions.

Remember, your child might or might not tell you about their symptoms, so watch out for them yourself:

  • Nausea 

  • Weight loss

  • Stomach cramps and pain

  • Complaints of indigestion or stomach pain

  • Bad breath

  • Tooth decay

How is Rumination Syndrome diagnosed?

Because RS symptoms are similar to ordinary stomach upsets and vomiting, it is often misdiagnosed as something else, such as gastroesophageal reflux disease or delayed gastric emptying. 

Also, RS symptoms can vary greatly between patient to patient. Your doctor can give an accurate diagnosis after taking a detailed history of your child’s symptoms.

These are some of the questions that your doctor will ask:

  • What does the food your child regurgitates look like?

  • How does it smell?

  • How does the regurgitated food taste to your child?

  • How long after a meal or mouthful does it take for the food to be regurgitated?

  • Does the regurgitation process ever wake your child when they are asleep?

  • Does retching or heaving accompany the regurgitation?

  • What, if any, medications does your child use to treat the regurgitation of food? 

  • Do any of the medications you have tried help the reflux?

Only when the clinical description of RS signs and symptoms have been firmly established will a diagnosis be made. However, to fully diagnose rumination syndrome, blood tests, internal imaging, and/or a gastroscopy are often carried out to make sure it is the correct determination. It’s very important to rule out other causes for the symptoms. The tests will also evaluate your child for dehydration and malnutrition.

What is the treatment for Rumination Syndrome?

The management of RS is a holistic combination of both medical and behavioural treatments. According to recent research, the best way to inhibit rumination syndrome symptoms is for your child to relearn the process of eating and digesting.

If your child’s weight gains and growth have been negatively impacted, the treatment will also include a nutritional rehabilitation process. 

Dietary management will include:

  • The importance of eating and absorbing the right balance of nutrition.

  • Monitoring in case supplemental enteral nutrition is required (enteral means nutrition that passes all the way through the digestive system to be absorbed).

  • Behavioural therapy treatment for rumination, which includes strengthening diaphragmatic breathing exercises.

  • Learning strategies that prohibit the regurgitation sensation from reoccurring. 

  • Exposure therapy techniques; ‘catching’ the urge to regurgitate and suppressing it before it happens.

What medicines are used to treat Rumination Syndrome?

Omeprazole: A stomach coating medication that reduces the production of stomach acid. It protects the lower esophageal sphincter and the oesophagus from stomach acid reflux.

Domperidone: A prokinetic agent. Domperidone helps the stomach empty faster, which reduces the volume of food and liquid in the stomach area. 

What is the long term prognosis for a child with Rumination Syndrome?

The long-term outlook for a child with Rumination Syndrome is good. Because the reasons why RS starts are not clear, the symptoms are managed with medicines while behavioural therapy is ongoing. 

The goal for every parent with a child who has rumination syndrome is to work closely with your gastroenterologist and therapist so that the pattern of chewing, swallowing, and regurgitation is ended.

Fortunately, once it is diagnosed, Rumination Syndrome is not able to do more physical damage. And while the symptoms can lead to weight loss, negative gains, and short term problems with the oesophagus, consistent management of the problem will help your child to avoid long-term complications in later life.

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