Rumination Disorder Treatment

Rumination disorder can be treated through behavior modification, habit reversal training and diaphragmatic breathing exercises.

Treatment forrumination disorderdepends on accurate diagnosis and finding the underlying cause of the disorder. It also encompasses managing symptoms and reducing complications that may arise as a result of regurgitating food, rechewing it and swallowing it again. Rumination disorder treatment is primarily psychosocial or psychodynamic and consists of non-punishing behavioral strategies.

According to theNationwide Children’s Hospital, the goals for treating rumination disorder are:

Habit-Reversal Training and Behavioral Modification

According to astudy posted in the Journal of Pediatric Gastroenterology & Nutrition, the three components of the simplified habit-reversal approach include:

In the study, the firsthabit-reversal trainingsession consisted of the patient identifying the rumination with regurgitation and receiving instructions to record each time it occurred. Afterward, during the practice of diaphragmatic breathing, the patient was instructed to breathe slowly and to keep her chest from moving while making her abdomen rise and fall during breathing. The goal of this exercise was to make each inhale and exhale last for three seconds. At home, the client would practice diaphragmatic breathing after meals for three five-minute periods of inactivity with 10-minute breaks in between.

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Diaphragmatic Breathing

Diaphragmatic breathing is a technique used to treat rumination disorder. By usingdiaphragmatic breathing exercises, the person uses a relaxation technique to inhale and exhale by expanding the abdomen instead of the chest. This type of breathing is incompatible with regurgitation of food, meaning a person can’t engage in rumination behaviors while practicing this breathing.

Diaphragmatic breathing in rumination syndromecan be practiced throughout mealtimes and for 10 minutes after the meal to allow the food to pass further down the stomach closer to the small intestine. The deep inhales and exhales move the abdomen and not the chest wall.

Relaxation Techniques

Currently, themost effectivetreatment strategies in rumination disorder consist of behavioral therapy focusing on breathing and relaxation techniques. Breathing techniques use habit reversal to create a competing behavior (or a distraction) to reduce the regurgitation episodes.

Relaxation techniques combined with diaphragmatic breathing and music help the patient relax, which reduces the likelihood that they will ruminate. Although complete reprogramming is necessary for sustained recovery, it’s best to start with snacks and small meals and advance the diet slowly to full meals. Education and realistic expectations during times of stress are additional tools a person can use to avoid setbacks.

Mild Aversive Training

Mild aversive training strategies are recommended only if the individual’s health is not at risk for deterioration. Mild aversive training includes:

Stronger aversive strategies are usually used in refractory cases that are causing significant malnutrition, hospitalizations or electrolyte disturbances that might affect the heart. They include the following:

Related Topic:Aversion therapy

Supportive Therapies

Rumination disorder strategies must include education for both the parents and child, rebonding of the parent and child, counseling, support groups, stress reduction and treating underlying psychopathologies likedepressionoranxiety.

Medications

Medications for rumination disorder cantarget multiple potential causal factors, including those to help the stomach accommodate the food, or empty, faster. The esophageal sphincter might be manipulated with medication. Medication for rumination disorder may include:

Treatment in Children vs. Adults

Rumination treatmentin childrenis easier than with adults. For example,chewing gum in rumination is effective in children. Difficulty in the treatment for rumination disorder in adults is due to the long-standing nature of the condition. Some infants and children outgrow rumination disorder spontaneously. However, adults may be more motivated to correct the condition than children are, due to embarrassment. Additionally, adults can follow instructions more diligently than children can.

In the case of maternal neglect, an infant may use rumination as a way to stimulate him or herself. In cases of an over stimulating environment, the infant may use it as a way to self-soothe.

Rumination Disorder Prognosis and Outlook

In the case ofrumination disorder, it is necessary to rule out underlying gastrointestinal diseases such as gastroesophageal reflux. Psychiatric evaluations can uncover other contributing factors, such as underlying depression or anxiety. Once the underlying cause of rumination is determined, rumination disorder prognosis is good.

Complications such as aspiration, bronchitis, pneumonia and asthma may be seen if there is a delay in diagnosing and treating the condition. Premalignant changes in the esophagus should be assessed in any long-standing cases of rumination disorder.

Other possible complications of untreated rumination disorder are:

While it may be rare, a person with rumination disorder may misuse drugs or alcohol. If you or someone you know struggles with drug or alcohol abuse and aco-occurring mental health conditionlike rumination disorder, help is available. The Recovery Village offers co-occurring disorder treatment programs to help heal substance abuse and mental health issues.Call todayto learn more.