What is rumination syndrome?

Rumination syndrome is a disorder of gut-brain interaction (DGBI), meaning the digestive system may look healthy, but it does not work in the typical way. In rumination syndrome, food that was just eaten may come back up into the mouth because muscles in the belly and diaphragm tighten at the wrong time, pushing food up and out of the stomach. This is not forceful like vomiting and gagging; in fact, foods and liquids come back up easily into the throat or mouth after eating or drinking. Rumination usually takes place during a meal or snack or soon after, and it might occur each time someone eats or drinks.

Rumination happens when there is a change in how the signals between the brain and stomach are working. This change causes the brain and stomach to get stuck in a pattern of bringing foods and liquids back up after swallowing. Over time, this pattern becomes an automatic response to eating and drinking. It’s like the stomach learned to get rid of foods and liquids instead of keeping them down. Even though rumination happens automatically, there are things you can do to help the body unlearn this habit.

Rumination syndrome is diagnosed by a healthcare professional in the office, based on the observed and reported symptoms. No specific tests are required.  Multiple studies have shown that the most successful treatment for rumination syndrome is diaphragmatic breathing. Children with rumination syndrome should practice diaphragmatic breathing exercises to help retrain their bodies for successful eating and swallowing.

What is diaphragmatic breathing?

Diaphragmatic breathing, also called “belly breathing,” is a gentle breathing technique that uses the diaphragm, a muscle below the lungs, to help the body stay relaxed while eating. When you breathe this way, the belly rises and falls while the chest stays mostly still. For people with rumination syndrome, diaphragmatic breathing can help food and drinks stay in the stomach instead of coming back up. 

What are the benefits of diaphragmatic breathing for rumination syndrome?

• Diaphragmatic breathing is a key treatment for rumination syndrome because it works as an opposite action. This means when the belly rises during a diaphragmatic breath, it becomes harder for the stomach muscles to squeeze and push food out of the stomach after eating. 
• Using diaphragmatic breathing for rumination syndrome during and after meals helps keep food and liquids in the stomach, where they belong. 
• Practicing diaphragmatic breathing regularly can help break the cycle of rumination over time. 
• Diaphragmatic breathing may also help the body stay calm and relaxed, especially if eating causes discomfort or stress.

How to practice diaphragmatic breathing for rumination syndrome

With diaphragmatic breathing, or belly breathing, the belly gently expands as you breathe in and softly relaxes as you breathe out. This breathing pattern can help retrain the body and is an important skill for people learning breathing exercises for rumination syndrome.

Diaphragmatic breathing instructions, step by step

1. Choose a comfortable position.
   You can sit upright, lean back in a chair, or lie flat on your back. 
2. Place your hands to guide your breathing. 
   Rest one hand on your chest. Place your other hand on your belly, near your belly button. 
3. Check in with your breath. 
   Take a few slow breaths and notice which hand moves more. 
4. Breathe in slowly. 
   Inhale through your nose. Let your belly gently expand while your chest stays mostly still. 
5. Breathe out with control. 
   Exhale slowly through your mouth, allowing your belly to soften and move back toward your spine. 
6. Continue the pattern. 
   Repeat this breathing for about 5 to 10 breaths, focusing on smooth, relaxed movements. 

How often should I practice diaphragmatic breathing exercises? 

Most children should practice diaphragmatic breathing for rumination syndrome several times each day, especially before, during and after meals. 

A typical starting plan:

• Practice 5 to 10 slow breaths at a time 
• Use breathing before meals, during meals and for a few minutes after eating 
• Add practice during calm times, like resting or getting ready to eat  

Consistent practice helps this breathing pattern feel more natural and easier to use when food is in the stomach. Your healthcare team may adjust your plan based on your child’s needs; always follow their guidance. 

How parents and caregivers can help their child with diaphragmatic breathing for rumination syndrome

• Stay calm and neutral during symptoms. If food comes back up, try not to react with worry, frustration or urgency. Remaining calm helps your child feel calm and confident to practice their diaphragmatic breathing. 
• Encourage practice without pressure. Gently remind your child to use diaphragmatic breathing for rumination syndrome before, during and after meals. 
• Practice together when possible. Modeling diaphragmatic breathing can help your child learn the correct technique. It's normal for your child to need some time to get comfortable with this type of breathing. 
• Create a low‑stress eating environment. Keep mealtimes predictable and relaxed and avoid rushing or focusing too much on symptoms. Remind your child to eat slowly, take smaller bites and fully chew their food. A calm environment helps your child learn and practice diaphragmatic breathing more effectively. 
• Reinforce effort, not perfection. Praise your child for practicing diaphragmatic breathing, even if symptoms still happen. Progress takes time, and consistency matters more than immediate results. For younger children, this may include using a reward chart to encourage them to practice.