Rumination, Pica, and Elimination (Enuresis, Encopresis) Disorders

Published on 22/03/2015 by admin

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Last modified 22/03/2015

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Chapter 21 Rumination, Pica, and Elimination (Enuresis, Encopresis) Disorders

21.1 Rumination Disorder

Rumination disorder is defined as the repeated regurgitation and rechewing of food for a period of at least 1 mo following a period of normal functioning. The rumination is not due to an associated gastrointestinal illness or other general medical condition (e.g., esophageal reflux). It does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Malnourishment with resultant weight loss or growth delay is a hallmark of this disorder. If the symptoms occur exclusively during the course of mental retardation or a pervasive developmental disorder, they must be sufficiently severe to warrant independent clinical attention.

21.2 Pica

Pica involves the persistent eating of nonnutritive substances (e.g., plaster, charcoal, clay, wool, ashes, paint, earth). The eating behavior is inappropriate to the developmental level (e.g., the normal mouthing and tasting of objects in infants and toddlers) and not part of a culturally sanctioned practice.

21.3 Enuresis (Bed-Wetting)

Enuresis is defined as the repeated voiding of urine into clothes or bed at least twice a week for at least 3 consecutive months in a child who is at least 5 yr of age. The behavior is not due exclusively to the direct physiologic effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder). Diurnal enuresis defines wetting while awake and nocturnal enuresis refers to voiding during sleep. Primary enuresis occurs in children who have never been consistently dry through the night, whereas secondary enuresis refers to the resumption of wetting after at least 6 months of dryness. Monosymptomatic enuresis has no associated daytime symptoms (urgency, frequency, daytime enuresis), and nonmonosymptomatic enuresis, which is more common, often has at least one subtle daytime symptom. Monosymptomatic enuresis is rarely associated with significant organic underlying abnormalities.