Rumination Disorder: Causes, Epidemiology and Treatment

Rumination Disorder Causes, Epidemiology and TreatmentRumination turnover is an eating overthrow whereby an infant or toddler brings back up and re-chews intellectual nourishment that was already swallowed and digested. This is known as regurgitation. In most cases, the re-chewed food is then swallowed again but occasionally, the nipper provide spit it out. For this to be considered a disorder, the behaviour moldiness have move onred to a child who had been eating normally previously, and it must occur frequently for atleast a month. The behaviour whitethorn occur during feed or decently after eating.What Are the Symptoms of Rumination Disorder in Babies and Kids?Symptoms of rumination disorder in infants and toddlers may include (1) repeated regurgitation of food (2) repeated re-chewing of food (3) weight loss (4) repeated stomach aches (5) raw and chapped lips. Infants, in addition, may make unusual movements such as straining and arching the back, guardianship the head ba ck, tightening abdominal muscles and making sucking movements with the mouth. These movements could suggest that the infant is trying to bring back up the partially digested food.What Causes Rumination Disorder?The take in cause of rumination disorder is unknown although thither several speculation. consort to () some factors that may contribute to this disorder atomic number 18 those that argon physical. Physical unhealthiness or stress may trigger the behaviour. It may be a way for the child to get attention it has been found that neglect from the primary feel for giver may cause the child to engage in self-importance comfort.It has been found that rumination may occur in a state of self relaxation , self absorption and self pleasure. It appears to have a self soothing or self stimulating function. The infant gets some satisfaction from this.For the kickoff four to six months of an infants life, breast milk or an alternative formula is a babys source of energy and nutrients (Santrock, 2011). it has been found that breast cater infants have lower respitory tract infections, they atomic number 18 less likely to develop otitis media (a middle ear infection) and breast fed infants have fewer gastrointestinal infections (Santrock, 2011). According to (Chial, Camilleri, Williams, Litzinger, Perrault, 2003) rumination is a functional gastrointestinal infection. This suggests that thither is a possibility that children who develop this disorder may have had a lack of breast feeding as an infant which further elaborates that neglect from the primary caregiver is vital. Rumination is common in disorders such as bulimia nervosa. It is a learned disorder and comes from a manifestation of rejection.http//www.webmd.com/children/guide/eating-disorders-in-children-rumination-disorder?page=3EpidemiologyIt is difficult to know exactly how many people are affected by this disorder principally because most cases are not reported. Children tend to outgrow it and as th ey grow into the adolescent stages and adulthood, they become embarrassed by it and it lots happens in secret. Rumination disorder is generally uncommon. Rumination disorder occurs often in infants between the ages of three and twelve months as well as in children with cognitive impairments. It may occur slightly to a greater extent often in boys than in girls, but few studies of the disorder exist to confirm this. (webmd)For the purpose of this paper, the South African context allow for be put into consideration. It is important to remember that accreditedity is socially constructed. South Africa is a diversified country with many elaborations. Amongst many of the African socializations, western culture is often overlooked and shunned upon. It is difficult to change the minds of others and it would be unethical for an outsider to come and talk against their belief systems.When there is behaviour that is unusual, it is common for the average traditionalistic African woman or m an to put their trust in the customary traditional healer. People tend to keep their parental and ancestral roots, this is sooner common to a greater extent often in the homelands where majority of the financially deprived stay even though some times it happens that those who move to the city to look for jobs may adopt new ways of thinking but still truly remaining to their roots. Because of these strong traditional beliefs, primary caregivers may opt for traditional healers than westernised medical examination attention. It is in any case much easier to go to a traditional healer than it is finding a good clinic or good health care facility. The social and sparing pressures make it hard for children to get the right kind of medical attention. It is common for these primary caregivers to believe it is witch craft, it is something they learn. When something cannot be explained, it is easier to put blame in witchcraft.often with grandparents staying in rural areas and the younger p eople moving to the cities in search of employment, better education, and health care. The effects of disrupted bonds are manifold. In our field, the geographical insulation between young stupefys and the maternal grandmothers has particularly far reaching consequences.We have called our Service theMdlezana Centre. This is a Xhosa word depicting the early bond between mother and child, when they are still one unitequivalent to the Winnicottian term of the state of primary maternal preoccupation.Infant Mental Health was a new purpose in 1995, but it took root in the city of Cape Town immediately. in that respect are no problems in obtaining referrals to the Rondebosch pillar in fact, at times we are inundated, and can barely cope with the workload. In Khayelitsha, the situation is different and the population was initially hard to reach. There are various reasons for thisIn a community where unemployment is unimaginably high, where families are disrupted, where there is often no food, the emotional life of the infant is not a priority.Mothers, who are the main caregivers (I have solely seen fathers on two occasions in the past five years) are often depressed and suffer in silence. They have a helplessness that is real and in a way adaptive in the sense that the great majority of women have no choice, but to cope and make do with what they have. They render their fate stoically and will not spontaneously open up.Then there are cultural factors in that one does not easily parcel with strangers ones intimate family problems. There is a sense of privacy and possibly shame and thus problems are often borne silently. A visit to a Traditional Healer is for many a more familiar option. I shall return to this point shortly.The infants themselves are mostly not a problem they are generally quiet and seemingly contentthis is an observation that all western visitors who come with me to the clinic make. The wait is often long, but the noise level low and there is imme nse patience, even in the babies and toddlers. It is only the physically obvious, such as delayed milestones, that will readily be seen as a reason for a consultation.On a diagnostic level the infants fall into three broad categories developmental delay, failure to thrive, and increasingly, depression.When a condition sets in after birth, then the figurehead of evil spirits or bewitchment isvery much in the foreground. For whatever individual reason, the protection of theancestors has been withdrawn and the child has become exposed to forces of evil, theimpundulu. The muthiis express to drive out the evilspirit or to strengthen and protect the child against it. Mostly these interventions areharmless from a medical perspective however, there are some mixtures which, wheningested, can cause gastrointestinal symptoms.Operations and anesthetics are at times viewed with great fear. This may have to dowith a grown up of the child to be put to sleep which, in effect, could mean a kindof death. The father of one ill infant whom we saw and who require surgery spokeabout sacrificing his child. The healer who was involved in this case also said to theparents that surgery would interfere with the workings of themuthihe was using. Theend result was that the child did not receive the operation in time and died.A working alliance with traditional healers is being established with the recent foundingof the Traditional Healers Association. It is hoped that with collaborating with the traditionalhealers in diagnosis and treatment gaps can be bridged and unnecessary suffering be prevented.I will end this section by giving a brief case illustration.How Is Rumination Disorder Diagnosed in Infants and Children?The diagnosis of rumination syndrome is based upon the characteristic symptoms and the absence of signs of disease. Although diagnostic criteria (symptombased, Rome II) for childhood functional gastrointestinal disorders have been developed, such criteria for children and adolescents with rumination syndrome have not been defined. The lack of formal criteria for diagnosing rumination syndrome in children and adolescents likely contributes to the lack of awareness of the condition and to the trouble in making the diagnosis. We anticipate that such criteria will be developed in the future.How Is Rumination Disorder Treated in Children?Rumination disorder is a voluntary, learned behaviour which patients are frequently unaware. As infants grow older, clinical features of regurgitation are similar to those of bulimia nervosa. Before one can be diagnosed it has been found that individuals with this disorder undergo several medical interventions and experience prolonged symptoms in the lead a diagnosis is made. (Chial, La Crosse, Camilleri, Bean, 2009)One important aspect in the history is the timing of the regurgitation. Diaphragmatic eupnoeic has been shown to be clinically beneficial in rumination syndrome although this type of treatment can only ta ke place starting line from ages where toddlers can understand. According to (Chiktara, van Tilburg, Whitehead, Tall, 2006) this method is useful to treat children as young as six years of age. Patients should be encouraged to practice diaphragmatic breathing midway through the meal or after meals for three different 5 min periods of inactivity with 10 min in between periods. They should also repeat this plan after each episode of regurgitation. The goal is for diaphragmatic breathing to occur unconsciously during events that may incur regurgitation.Treatment of rumination disorder mainly focuses on changing the childs behaviour. Several approaches may be used, includingContinue reading belowChanging the childs posture during and right after eatingEncouraging more interaction between mother and child during feeding giving the child more attentionReducing distractions during feedingMaking feeding a more relaxing and pleasurable experienceDistracting the child when he or she begins the rumination behaviorAversive conditioning, which involves placing something sour or bad-tasting on the childs tongue when he or she begins to vomitPsychotherapy for the mother and/or family may be helpful to improve communication and address any negative feelings toward the child due to the behavior.There are no medications used to treat rumination disorder.What Complications Are Associated With Rumination Disorder?Among the many potential complications associated with untreated rumination disorder in infants and children areMalnutritionLowered resistance to infections and diseasesFailure to grow and thriveWeight lossStomach diseases such as ulcersDehydrationBad breath and tooth decay design pneumonia and other respiratory problems (from vomit that is breathed into the lungs)ChokingDeathWhat Is the Outlook for Children With Rumination Disorder?In most cases, infants and young children with rumination disorder will outgrow the behavior and return to eating normally. For older chil dren, this disorder can continue for months.Can Rumination Disorder Be Prevented in Infants and Children?There is no known way to prevent rumination disorder in infants and children. However, careful attention to a childs eating habits may help catch the disorder before serious complications can occur.(culture and psychiatry journal)The culture of the patientIn addition to individual factorssuch as level of education, medical knowledge, and personal life experiencesculture will contribute to the patients understanding of illness, perception and presentation of symptoms and problems, and reaction and adjustment to illness. The patients expectations of the physician, motivation for treatment, and compliance with treatment recommendations are also influenced by culture.