Rome IV Diagnostic Criteria for Child Rumination Syndrome
Official Rome IV criteria for the diagnosis of child rumination syndrome.
Use in children and adolescents with symptoms suggestive of rumination, such as persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or rechewing and re-swallowing for at least 2 months.
Patients with any of the following features must be evaluated clinically for other diagnoses even though rumination syndrome may be present:
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Dysphagia.
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Odynophagia.
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Persistent vomiting.
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Vomiting later than 4h after a meal.
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Nocturnal vomiting.
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Unintentional weight loss.
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Signs of upper gastrointestinal bleeding.
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Severe abdominal pain.
If diagnosis not met (negative):
Symptoms unlikely to be caused by rumination syndrome. Consider further assessment as clinically indicated.
If meets diagnosis (positive):
Likely diagnosis of rumination. Consider initiating treatment.
Management of rumination syndrome may include:
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Education.
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Diaphragmatic breathing.
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Patient motivation is key in achieving success.
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Progressive muscle relaxation and biofeedback.
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Small, frequent sips or meals.
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Baclofen.
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Nasogastric or even post-pyloric feeding can become necessary if weight-loss is significant.
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Prokinetics and pyloric botox have been used in children and adolescents with varying degrees of success.
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Intensive inpatient interdisciplinary rehabilitation is sometimes needed in refractory cases.
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in pediatric patients who do not have signs or symptoms suggestive of a structural, metabolic or systemic cause of their symptoms based on clinical history, physical exam, and initial work-up.