Eliminating Rumination in Developmentally Disabled Children: A Case Report

• Published in: Pediatrics (Evanston) 2015-07, Vol.136 (1), p.e249-e251
• Main Authors: Severio, Amber, Monagas, Javier, Noel, R Adam, Hyman, Paul E
• Format: Article
• Language: English
• Subjects: Care and treatment; Caregivers; Child, Preschool; Children; Children with disabilities; Developmental Disabilities - complications; Developmental Disabilities - rehabilitation; Developmentally disabled; Developmentally disabled persons; Disabled Children - rehabilitation; Enteral feeding equipment; Enteral Nutrition - methods; Feeding and Eating Disorders of Childhood - etiology; Feeding and Eating Disorders of Childhood - therapy; Female; Health aspects; Humans; Intubation, Gastrointestinal; Male; Medical treatment; Pediatrics; Practice
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-4100

Rumination is the effortless regurgitation of food, with subsequent spitting out or rechewing and reswallowing. In developmentally delayed children, rumination is a pleasurable, self-stimulating habit. For 3 years, we evaluated and treated 2 nonambulatory, nonverbal 4-year-old children who ruminated frequently while awake. The social isolation caused by a child covered in regurgitated food prompted caregivers of these children to find a solution. We hypothesized that rumination would cease if the stomach stayed empty of food. We intervened by placing gastrojejunostomy tubes and then initiated continuous drip jejunal tube feedings over 12 waking hours to reduce hunger; the children's oral diet was also stopped. In both cases, these changes reduced episodes of rumination to 3 to 5 times daily. To eliminate rumination, unpleasant tasting substances (N-acetylcysteine or cayenne pepper-based hot sauce) were given through the gastrostomy tube every 4 hours while the children were awake. Within 1 week of adding the unpalatable substances, rumination ceased. After 2 months of no rumination, 1 mother restarted oral feeding. There was no recurrence of rumination, and 3 months after gastrojejunal tube placement, the tube was removed. In 1 year of follow-up, rumination did not recur. The second mother was pleased with the outcome with jejunal feedings and chose not to resume oral feedings. These results showed that jejunal tube feeding in combination with insertion of unpalatable contents into the stomach eliminated rumination in these developmentally delayed children.