Rumination in infancy: Recent behavioral approaches

Abstract

The published literature on behavioral treatments of rumination is reviewed, and new case material on two recently reported procedures is presented. Rumination, a medical condition of infancy involving repeated regurgitation of previously ingested food, has historically been treated from a psychodynamic approach involving extended in‐patient treatment by mother surrogates. This procedure is both time‐consuming and very costly. The initial behavioral approach involved electric shock. Single‐case studies reflect the utility of this procedure, but widespread resistance to this form of punishment makes this a difficult procedure to utilize. More recent behavioral procedures reported in single‐case studies have included delivering aversive taste stimuli as consequences for ruminating. This procedure has met with mixed success, and has the added drawback of being difficult to implement technically and because of staff resistance. A combination of punishment by scolding, time‐out, and reinforcement of retaining the food constitutes a useful alternative. This procedure has the added advantage of being more acceptable to staff and implementable at home. The possibility of individual differences among ruminators that might predict success is also raised.

Rumination

“…Another study found that the mothers of ruminating infants tended to have high degrees of depression and an impaired coping style, characterized by high degrees of dependency and immaturity [12]. However, other investigators have suggested that infant rumination is actually a learned behavior, in which infants who received attention in response to episodes of rumination were more likely to repeat it and that "extinguishing" the rumination behavior with negative reinforcement (ie, aversive stimuli or withdrawing attention) may be an effective treatment strategy [13].…”

“…Operant conditioning has been shown to be helpful in treating infants or severely developmentally disabled children with rumination [13,24]. The selective withdrawal of attention in response to rumination and the application of additional attention in response to appropriate feeding behavior have been used effectively by a number of clinicians.…”

Merycism or Rumination Disorder

“…In some subjects it was directly imitative, â€oe¿ a learned habit― (Levine et a!, 1983);in others, particularly infants and the mentally defective, securing attention, either as care or disapproval, acted as a reinforcer, which required countering by a consistent programme of social rewards and punishments (Chatoor eta!, 1984). Most controversial were aversive techniques, such as electric shock, first used with older, mentally retarded subjects in 1968, and with infants in 1969 (Lavigne et a!, 1981) and the application of unpleasant substances to the tongue (e.g. lemon juice, tabasco sauce).…”

“…The teenage male described by Vos (1830) was entirely fit; Effiotson (1835) referredto an octo genarianruminatorin perfect health, and Bourneville and Séglas (1883) confirmed that merycism could occur in completely healthy individuals. Runge (1895) described a ruminating father and son who were strong and well; Osler (1912) asserted that â€oe¿ the habit does not necessarily impair the health―.More recently, Lavigne et a! (1981) warned against the assumption of psychopathology in ruminators and their families and Levine eta!…”

“…Their claim that no evidence existed of infant ruminators showing neurotic tendencies in later life was, however, contested by Kanner (1936) and Geffen (1966). Lavigne et a! (1981) interpreted infantile rumination as symptomatic of a broader syndrome, where there was underlying anxiety, neuroticism or depression.…”