Intensive Outpatient Treatment of Pediatric Rumination Syndrome in the Era of Telemedicine

Abstract

Objectives: We have had success treating children with severe rumination syndrome using a multidisciplinary intensive outpatient program (IOP) involving multiple treatment sessions daily. During the coronavirus disease 2019 (COVID-19) pandemic, we temporarily transitioned care to telemedicine. The objective of this study is to compare outcomes of patients with rumination syndrome who completed IOP treatment in person versus by telemedicine. Methods: We performed a retrospective review of patients diagnosed with rumination syndrome who participated in IOP treatment from 2018 to 2020. Similar treatment sessions were performed involving medical and behavioral techniques provided by a multidisciplinary team during telemedicine visits. Families/patients were asked to complete a survey outlining their child’s current rumination symptom severity and review the IOP. Results: We included 34 patients (79% F, median age 15 years, range 7–19 years) who completed IOP treatment. Twenty-six patients (76%) were treated in person and 8 patients (24%) by telemedicine. For patients treated in person, 76% (19/25) had improvement in symptoms while 16% (4/25) had complete resolution of symptoms. For patients treated by telemedicine, 88% (7/8) had improvement in their symptoms. There were no significant differences between groups in likelihood of improvement. Overall, 78% (18/23) preferred in person therapy while 17% (4/23) did not have a preference. All 18 of the in-person cohort who completed follow-up surveys preferred in-person management. Conclusions: Multidisciplinary intensive outpatient treatment for children and adolescents with severe rumination syndrome is effective. Although telemedicine may be an alternative to in person therapy, majority of families prefer in person visits.

Nonpharmacological treatment of rumination syndrome in childhood: A systematic review of the literature

“…S6. DB was the most used treatment, even though it was combined with other therapeutic strategies (biofeedback, 3,17,20 cognitive-behavioral therapies, 3,17 relaxation training, 3,17 reswallowing regurgitation, [18][19][20] distraction strategies, 19,20 counseling, 3,12,[17][18][19] slow pace of eating, 18,19,21 posture while eating, 18,19,21 smaller portions 19,21 ).…”

“…The included studies reported the outcomes expressed as "resolution," 3,12,[17][18][19][20][21] "improvement," 3,12,[17][18][19][20][21] "positive impact on symptoms," 3 "partially responding," 12 "nonresponders," 3,12,[17][18][19][20][21] "worsened," 18,19 "relapsed" 12,17,21 on different variables rumination, 17 reswallowing, 18,19 vomiting, 18,19 number of not-consumed meals, [17][18][19][20] need for enteral or parenteral food supplementation, [18][19][20] weight loss, [18][19][20] and loss of social and school activities. 17,19 The findings were heterogeneous: remission ranged from 0% 18 to 100%, 17 improvement from 8.33% 17 to 87.5%, 18 and nonresponse from 4.2% 18 to 16.6%. 17…”

Intensive Outpatient Treatment of Pediatric Rumination Syndrome

“…The treatment protocol remained the same, with the initial intake visit including both gastroenterologist and psychologist, followed by two to three treatment meals daily for 2-4 days following the intake. To evaluate effectiveness of the virtual IOP, our team conducted a study using patients who had completed in person and patients who had completed virtual IOP (Hawa et al, 2022). The study included 34 patients, 26 of which were in person and eight who were virtual for the program.…”

Disorders of Gut‐Brain Axis

“…In this issue of JPGN , 2 studies from Nationwide Children’s Hospital provide evidence that multidisciplinary tiered care is effective for rumination syndrome, even when some elements may be provided by a telehealth care model (7,8). In a compelling retrospective review of over 170 typically developing, mostly adolescent patients, Sabella et al (7) demonstrate that outpatient, intensive outpatient (IOP), and intensive inpatient programs (IP) led to better or fully resolved symptoms in 72%, 95%, and 96% patients, respectively (Fig.…”

“…Similar approach has also been shown to be effective in both functional as well as organ-based conditions such as inflammatory bowel disease (10). In the second report, effective completion of behavioral therapy by telemedicine was noted to be comparable to in-person therapy outcomes (8). Interestingly the authors report that most of the families in fact preferred in-person visits.…”