Core features

• Voluntary or involuntary regurgitation of recently eaten food, typically within minutes to an hour after eating.
• Regurgitated food is not due to gastroesophageal reflux disease (GERD) with retching, nor intentionally vomited; there is often absent nausea.
• Causes distress or impairment (nutritional, social, medical) and is not attributable to another medical condition or mental disorder (unless specified as comorbid).

Who is affected & common associations

• Infants and young children: may present as persistent regurgitation, poor weight gain, or aversive feeding behaviours.
• Older children, adolescents and adults: associated with neurodevelopmental disorders (autism, intellectual disability), stress, prior choking experiences, or coexisting eating disorders.
• Prevalence is low but may be under‑recognised; consider in chronic regurgitation without typical GERD features.

Assessment checklist

1. History: timing and frequency of regurgitation, relation to meals, characteristics of regurgitated material, associated symptoms (nausea, retching, pain), weight trend, and feeding practices.
2. Developmental and psychosocial history: neurodevelopmental diagnosis, recent stressors, feeding environment, and caregiver responses that may inadvertently reinforce behaviour.
3. Medication and medical history: rule out medications that increase reflux, neurologic disease, gastroparesis or structural oesophageal disorders.
4. Physical exam: growth parameters, signs of malnutrition, dental erosion, electrolyte disturbance and abdominal or neurological findings.

Differential diagnosis

• Gastroesophageal reflux disease (GERD) with vomiting, vomiting disorder, avoidant/restrictive food intake disorder (ARFID) with regurgitation, rumination secondary to medication or medical illness, and factitious disorder or malingering (rare in children).
• Consider pH‑impedance monitoring or upper GI imaging if structural or reflux disease strongly suspected after initial assessment.

Investigations — when indicated

• Most cases diagnosed clinically. Investigations guided by red flags: weight loss, GI bleeding, progressive dysphagia, abnormal exam or poor response to behavioural treatment.
• Targeted tests: growth monitoring, basic labs (electrolytes, albumin), upper GI endoscopy, pH‑impedance, gastric emptying studies if gastroparesis suspected, and dental evaluation for erosion.

First‑line management — behavioural interventions

• Diaphragmatic (abdominal) breathing: taught to interrupt the regurgitation sequence — practice for several minutes after meals to prevent abdominal contraction patterns that precipitate rumination.
• Habit reversal and competing response training: identify triggers and replace the regurgitation with an incompatible posture/behaviour (sitting upright, sipping water, or gentle abdominal relaxation).
• Feeding/environmental modification: smaller, frequent meals; avoid overfilling, reduce distractions during meals, ensure upright posture for 30–60 minutes after eating in older children/adults.
• Caregiver training: avoid attention that reinforces regurgitation, use neutral responses, reinforce alternative behaviours, and maintain consistent mealtime routines.

Adjunctive medical & specialist strategies

• Treat comorbid conditions: optimize GERD treatment (PPI/H2 blockers) if coexisting reflux, manage constipation which can worsen regurgitation, and review medications that may contribute.
• In refractory cases consider referral to gastroenterology, nutrition/dietitian for caloric plans, speech and language therapy for oro‑motor techniques, and occupational therapy for sensory feeding issues.
• For severe, treatment‑resistant rumination with malnutrition consider temporary enteral feeding while behavioural therapies are instituted.

Psychological therapies

• Cognitive behavioural approaches to address stress, triggers and maladaptive coping; for comorbid mood/anxiety disorders provide parallel treatment.
• Applied behaviour analysis (ABA) for children with neurodevelopmental disorders — focus on reinforcement schedules, antecedent control and skill building.

Key takeaways

• Rumination disorder is diagnosed clinically—look for repetitive post‑prandial regurgitation without retching or nausea and assess for medical and developmental contributors.
• Behavioural interventions (diaphragmatic breathing, habit reversal, caregiver training) are first‑line and often highly effective.
• Coordinate multidisciplinary care (gastroenterology, dietetics, speech/OT, psychiatry) for refractory or complicated cases; address red flags urgently.