Rumination syndrome in children treated by increased holding

Rumination syndrome, the frequent regurgitation of previously ingested food into the mouth where it is chewed, is a common, life-threatening disorder of retarded individuals. Four cases are described in which holding a retarded, ruminating child for 10-15 min before, during, and after meals, was associated with remission of rumination. Simple holding was effective in three; in the fourth, it was necessary to punish the child by putting her into a separate room for 3 min immediately after regurgitations. A within-subject reversal experimental design suggested that holding and not simple distraction was the effective component of the treatment. Treatment benefits were well maintained when the child returned to a home environment in which he or she continued to be held periodically. It is proposed that there are two behavioral etiologies for idiopathic rumination syndrome, social deprivation and reward learning through increased attention for regurgitation. Holding is the treatment of choice for the first type, and punishment with time out may be necessary to suppress regurgitation in the second type.