- frequent regurgitation of previously ingested food into the mouth that
then is rechewed and either swallowed or spit out.
- effortless, not associated with forceful emesis. The infant appears
satisfied and calm.
- believed to be a behavioral mechanism for self-stimulation and pleasurable
- Although children who have rumination often mouth their fingers and fists
to initiate a gag reflex, some children learn to ruminate without obvious
- Chronic rumination may result in malnutrition, electrolyte disturbances,
and esophagitis and is associated with a mortality rate of 15% to 25%.
- Motility studies have revealed that rumination is associated with
voluntary abdominal wall contraction and pharyngeal maneuvers that
decrease upper esophageal sphincter pressure.
- Typically, rumination begins at 5 months of age, although it may begin at
- most frequently in mentally retarded children
- Mentally healthy infants who are abused or neglected and preterm neonates
who have limited contact with their parents also are at risk for developing
- 5 times more common among males than females.
- Rumination responds to increased personal attention and negative
- can be associated with gastroesophageal reflux and bulimia, making the
distinctions between these disorders difficult.
- Achalasia is characterized by increased lower esophageal pressure, absent
or incomplete relaxation of the lower esophageal sphincter, and defective
esophageal peristalsis and megaesophagus. Symptoms are insidious in onset and
include vomiting, dysphagia, weight loss, slow eating, and failure to thrive.
In younger children, coughing, choking, and recurrent pneumonia may be more
- Gastric outlet obstruction presents with forceful nonbilious emesis,
anorexia, and weight loss. Abdominal pain and distension may be noted.
Sandifer syndrome is associated with reflux and is
characterized by abnormal movement of the head and neck that results in
unusual posturing. It usually consists of sudden extension of the head and
neck into the position of opisthotonos. The movement is not related to the
activity, but typically it resolves during sleep. Sandifer syndrome is thought
to result in enhanced esophageal clearance of refluxed material.
- Many infants who have physiologic gastroesophageal reflux (GER) manifest
no symptoms other than emesis and may appear to ruminate. Dysphagia for both
solids and liquids may occur in older children. GER occurs in children who
have rumination and vice versa, but GER is not associated with repetitive
contractions of the abdominal musculature and often results in irritability
rather than a calming effect.
Fleisher DR. Functional vomiting disorders in infancy: innocent
vomiting, nervous vomiting, and infantile rumination syndrome. J
Herbst J, Friedland GW, Zboralske FF. Hiatal hernia and "rumination"
in infants and children. J Pediatr. 1971;78:261-265
Mayes SD, Humphrey FJ II, Hanford HA, Mitchell JF. Rumination
disorder: differential diagnosis. J Am Acad Child Adolesc Psychiatry.