Multidisciplinary Tiered Care Is Effective for Children and Adolescents With Rumination Syndrome

Abstract

Objectives: Rumination syndrome (RS) can be challenging to treat and data on treatment outcomes in children are limited. The objective of this study was to evaluate outcomes of children with RS treated with tailored outpatient and inpatient strategies. Methods: We performed a retrospective cohort study of children <18 years old with RS evaluated at our institution from 2018 to 2020. At our institution, we use a multidisciplinary, tiered approach to treatment based on presentation severity. Children with RS either undergo outpatient treatment program (OP) or participate in an intensive outpatient program (IOP) or an intensive inpatient program (IP). We reviewed baseline characteristics and assessed severity (including frequency of regurgitation/vomiting, route of nutrition, and weight loss) at baseline, at completion of treatment, and at a follow-up time point. Results: We included 171 children with RS (64% female, median age 13 years, interquartile range (IQR) 10-15), 123 of whom had post-treatment data after completing OP, IOP, or IP. At baseline, 66% of patients were vomiting daily and 40% were losing weight. After treatment, 72% of OP, 95% of IOP, and 96% of IP patients reported that symptoms were better or fully resolved compared to baseline. In all 3 treatment groups, patients were vomiting, losing weight, and skipping meals significantly less after treatment compared to baseline. At follow-up (median 5.3 months), 86% of IOP and 66% of IP patients had symptoms that remained better or resolved. Conclusions: RS can cause severe symptoms, impacting nutritional status and school participation. However, multidisciplinary care in a tiered approach leads to significant symptomatic improvement.

Early childhood‐onset rumination syndrome is clinically distinct from adolescent‐onset rumination syndrome

“…As described in a recent paper from our group, RS treatment at our institution is tailored to the child's clinical severity, with outpatient, intensive outpatient, and inpatient treatment programs. 6 We also documented parental perspectives on RS diagnosis, extent that RS symptoms bothered patients and parents, as well as patient school attendance. We also evaluated severity of rumination symptoms at baseline and follow-up, assessed based on regurgitation frequency (when rumination occurs but does not lead to vomiting), vomiting frequency (when rumination occurs and does lead to vomiting) and frequency of skipped meals, dependence on tube feeding or parenteral nutrition and presence of weight loss.…”

Intensive outpatient treatment of pediatric rumination syndrome.

“…Given the novelty of the Rumination syndrome IOP, evaluation of both treatment and cost effectiveness is important. In 2022, our team conducted an evaluation to compare treatment outcomes across different tiers of Rumi-nation syndrome treatment, including inpatient versus IOP (Sabella et al, 2022). Patients with available posttreatment data following were used for the study (inpatient treatment N = 23, IOP N = 19).…”

“…For example, a recent study on an outpatient treatment protocol for Rumination syndrome showed patients had decreased regurgitation symptoms following outpatient treatment (Lamparyk & Stephens, 2022). Further, inpatient treatment is rather expensive (Sabella et al, 2022; also see data later in this article) and, anecdotally, it is often difficult to obtain insurance approval for such treatment. At this author’s institution, patients would often be denied admission to the inpatient program by insurance companies due to not having a medically necessary reason for an inpatient hospitalization.…”

Patient education to increase behavioral treatment referrals for rumination syndrome.

“…BT includes diaphragmatic breathing as a competing response to rumination (Halland et al, 2018), and other behavioral strategies include mealtime modifications, graded food exposures, and reduction of reinforcing factors (Lamparyk & Stephens, 2022). Existing literature suggests that even brief BT is effective in reducing rumination frequency (Lamparyk & Stephens, 2022; Sabella et al, 2023).…”