1. Rumination, regurgitation, and vomiting, what’s the difference??? What is rumination? Rumination is when someone deliberately brings food or drink from their stomach up into their mouth, chews it and then swallows it again. This is different to regurgitation. What is regurgitation? Regurgitation is when someone’s food or drink from their stomach comes up into their mouth and is held there. What is vomiting? Vomiting is when this food or drinks comes out of the mouth. Signs and symptoms of rumination: Chewing after a meal is finished Chewed up food or drink in or around the person’s mouth after the meal is finished Food or drink on the floor or on the person’s clothing after eating Evidence of dental decay Halitosis (bad breath) Weight loss Dry and sore lips Repeated stomach ache and indigestion Why do people ruminate? Gastro - oesophageal Reflux Disease (GORD) Weakened upper oesophageal sphincter Self-stimulation Sensory seeking behaviour Attention seeking behaviour Boredom Assessment Considerations: Assessing a person who is thought to ruminate is an involved process, includes input from a range of health professionals and is different for each case. The following are considerations rather than steps for a comprehensive assessment. It is recommended that a General Practitioner (GP) co-ordinate the assessment. Comprehensive medical check up Assessment for Reflux Consulting a Multidisciplinary Team: General Practitioner, Speech Pathologist, Occupational Therapist, Dietitian, Behaviour Support Practitioner, Support staff. Oral Muscular Assessment Swallowing Assessment Positioning Food diary/Liquid Diary/Nutritional profile Data Collection Sensory Profile Behaviour Assessment Lifestyle Plan

2. Referral Pathways If you think that a person you support has regurgitation or rumination it is important that you seek medical advice. Please see a GP as a first step. They may provide a referral to other health professionals for further investigation and support. They may include a: Gastroenterologist Dietitian Speech Pathologist Psychologist Specialist hospital clinic Peanut butter: Peanut butter consumed before meals (Greene et al., 1991) Eating peanut butter 4 times per day and reducing fluids to half their average intake (Barton & Barton, 1985) Food Satiation: Continuous access to food (Woods et al., 2013) Adding extra fibre to meals (Rast et al., 1985) Unlimited quantities of starchy foods after mealtimes (Dudley et al., 2002) Supplemental feeding for 30 minutes after completion of their meal (Kenzer et al., 2007) Liquid Rescheduling: Withholding liquids for 60 minutes post mealtimes (Sharp et al., 2012) Withholding liquids for 90 minutes post mealtimes (Heering et al., 2003) Attention/Engagement: Providing the person with attention, reinforcement, activities and tasks (Wrigley at al., 2010) Reference List: Greene, K. S., Johnston, J. M., Rossi, M., Rawal, A., Winston, M., & Barron, S. (1991). Effects of Peanut Butter on Ruminating. American Journal on Mental Retardation, 95 (6), 631-645. Barton, L. E., & Barton, C. L. (1985). An effective and benign treatment of rumination. Journal of the Association for Persons with Severe Handicaps. Woods, K. E., Luiselli, L.K., & Tamossone, S. (2013). Functional Analysis and Intervention for Chronic Rumination. Journal of Applied Behaviour Analysis. 46, 328-332. Rast, J., Johnston, J. M., Allen, J. E., & Drum, C. (1985). Effects of nutritional and mechanical properties of food on ruminative behaviour. Journal of Experimental Analysis of Behaviour, 44, 195-206. Dudley, L. L., Johnson, C., and Barnes, R. S. (2002). Decreasing Rumination using a starchy food satiation procedure. Behavioural Interventions, 17, 21-29. Kenzer, A. L., & Wallave, M. D. (2007) Treatment of rumination maintained by automatic reinforcement: a comparison of extra portions during a meal and supplemental post- meal feedings. Behavioral Interventions, 22, 297–304. Sharp, R. A., Phillips, K. J. & Mudford, O. C. (2012). Comparisons of interventions for rumination maintained by automatic reinforcement. Research in Autism Spectrum Disorders, 6, 1107-1112. Heering, P.W., Wilder, D.A., & Ladd, C. (2003). Liquid rescheduling for the treatment of rumination. Behavioural Interventions, 18, 199-207. Wrigley, M., Kahn, K., Winder, P., Vollmer, T., Sy, J. (2010). A multi component approach to the treatment of chronic rumination. Behavioural Interventions. 25: 295-305. Interventions reported in the literature claiming to reduce rumination This list is not an endorsement or suggestions for intervention. You should discuss any intervention with a GP before commencing. You should read the entire article for the full description of the procedures used. Rumination project by ADHC Parramatta Speech Pathologists 2016