Rumination, RHC diagnostic and treatment algorithm

GGC Paediatric Guidelines
NHS GGC

Diagnostic Features

  1. Persistent regurgitation of recently ingested food with recurrent spitting or re-chewing
  2. Not preceded by retching
  3. Effortless not usually preceded by nausea
  4. Limited/no effect PPI (max 3mg/kg/day) 3 month trial
  5. Not waking at night to regurgitate

Table 1. Atypical features

  • overlapping reflux symptoms
  • significant nausea
  • weight loss
  • increase symptom severity (i.e. IVF as inpatient)
  • waking at night to regurgitate

Algorithm

Patient information

GIKids - Rumination Disorder

Editorial Information

Last reviewed: 15/12/2025

Next review date: 30/06/2028

Author(s): N. Britton.

Approved By: Medical Paediatrics

References
  1. Approach to disorders of gut brain interaction. Tome J et al. Mayo Clin Proc 2023; 98:458-67
  2. Multidisciplinary Tiered Care Is Effective for Children and Adolescents With Rumination Syndrome. Sabella J et al. J Pediatr Gastroenterol Nutr. 2023 Mar 1;76(3):282-287. 
  3. Rumination Syndrome in Children Presenting With Refractory Gastroesophageal Reflux Symptoms. Nikaki K. J Pediatr Gastroenterol Nutr. 2020 Mar;70(3):330-335.
  4. Rumination syndrome: pathophysiology, diagnosis and practical management. Sasegbon A, et al. Frontline Gastroenterology 2022;0:1–7.