# Rome IV child rumination

Rome IV Child Rumination

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/rome_iv_child_rumination`
HTML: https://magentlab.com/docs/rome-iv-child-rumination
Markdown: https://magentlab.com/docs/rome-iv-child-rumination.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Hyams 2016 Rome IV H1c child/adolescent rumination syndrome diagnostic criteria and return whether the published rumination box holds (rome_iv_child_rumination).

## When to use

When an agent already has the five caller-assigned Hyams 2016 Rome IV H1c flags and needs whether the published child/adolescent rumination box holds. magent does not observe regurgitation.

## When not to use

- Not a medical device.
- Not a diagnosis. magent does not diagnose rumination syndrome.
- The caller assigns the five flags, including not_explained_by_another_condition_or_eating_disorder. magent does not observe regurgitation and does not examine the child.
- This tool is Hyams 2016 Rome IV H1c child/adolescent rumination only. Not adult Rome IV rumination (Stanghellini 2016 B4). Not neonate/toddler rumination (Benninga 2016 G2).
- GERD-treatment failure and weekly frequency are not required (Rome IV dropped those). Manometry is not parsed.

## Formula

```
rome_iv_child_rumination iff repeated_regurgitation_rechewing_or_expulsion_soon_after_meals and does_not_occur_during_sleep and not_preceded_by_retching and not_explained_by_another_condition_or_eating_disorder and fulfilled_at_least_2_months (Hyams 2016 Rome IV H1c rumination syndrome)
```

## Citation

[Childhood Functional Gastrointestinal Disorders: Child/Adolescent](https://doi.org/10.1053/j.gastro.2016.02.015)
Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M
Gastroenterology. 2016;150(6):1456-1468
DOI: [10.1053/j.gastro.2016.02.015](https://doi.org/10.1053/j.gastro.2016.02.015)

## Worked example

### All five required flags

Given: `does_not_occur_during_sleep=true, fulfilled_at_least_2_months=true, not_explained_by_another_condition_or_eating_disorder=true, not_preceded_by_retching=true, repeated_regurgitation_rechewing_or_expulsion_soon_after_meals=true`

1. Repeated regurgitation and rechewing or expulsion soon after meals is true
2. Does not occur during sleep is true
3. Not preceded by retching is true
4. Not explained by another condition or eating disorder is true
5. Fulfilled at least 2 months is true
6. rome_iv_child_rumination is true


### Four required flags without 2-month duration

Given: `does_not_occur_during_sleep=true, fulfilled_at_least_2_months=false, not_explained_by_another_condition_or_eating_disorder=true, not_preceded_by_retching=true, repeated_regurgitation_rechewing_or_expulsion_soon_after_meals=true`

1. Repeated regurgitation and rechewing or expulsion soon after meals is true
2. Does not occur during sleep is true
3. Not preceded by retching is true
4. Not explained by another condition or eating disorder is true
5. Fulfilled at least 2 months is false
6. rome_iv_child_rumination is false


## Also searched as

- Rome IV child rumination
- Hyams 2016 rumination
- Rome IV H1c
- child adolescent rumination syndrome
- pediatric rumination
- H1c rumination syndrome
- Rome IV H1c rumination
- functional rumination child

## Parameters

- `repeated_regurgitation_rechewing_or_expulsion_soon_after_meals` (boolean, required): Repeated regurgitation and rechewing or expulsion of food that begins soon after ingestion of a meal, as assigned (Hyams 2016 Rome IV H1c). The paper's 1a (begins soon after meals) is folded into this flag. true or false as assigned by the caller. magent does not observe regurgitation.
- `does_not_occur_during_sleep` (boolean, required): The regurgitation does not occur during sleep, as assigned (Hyams 2016 Rome IV H1c). The paper's 1b (not during sleep) is this flag. true or false as assigned by the caller. magent does not observe regurgitation.
- `not_preceded_by_retching` (boolean, required): Not preceded by retching, as assigned (Hyams 2016 Rome IV H1c). true or false as assigned by the caller. magent does not observe regurgitation.
- `not_explained_by_another_condition_or_eating_disorder` (boolean, required): After appropriate evaluation, the symptoms cannot be fully explained by another medical condition, and an eating disorder has been ruled out, as assigned (Hyams 2016 Rome IV H1c). true or false as assigned by the caller. magent does not examine the child.
- `fulfilled_at_least_2_months` (boolean, required): Criteria fulfilled for at least 2 months prior to diagnosis, as assigned (Hyams 2016 Rome IV H1c). true or false as assigned by the caller.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/rome_iv_child_rumination`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "does_not_occur_during_sleep": "true",
      "fulfilled_at_least_2_months": "true",
      "not_explained_by_another_condition_or_eating_disorder": "true",
      "not_preceded_by_retching": "true",
      "repeated_regurgitation_rechewing_or_expulsion_soon_after_meals": "true"
    },
    {
      "does_not_occur_during_sleep": "true",
      "fulfilled_at_least_2_months": "true",
      "not_explained_by_another_condition_or_eating_disorder": "true",
      "not_preceded_by_retching": "true",
      "repeated_regurgitation_rechewing_or_expulsion_soon_after_meals": "true"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-child-rumination

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/rome_iv_child_rumination",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M",
        "doi": "10.1053/j.gastro.2016.02.015",
        "id": "hyams-2016",
        "pmid": "27144632",
        "source": "Gastroenterology. 2016;150(6):1456-1468",
        "title": "Childhood Functional Gastrointestinal Disorders: Child/Adolescent"
      },
      "formula": "rome_iv_child_rumination",
      "formula_expression": "rome_iv_child_rumination iff repeated_regurgitation_rechewing_or_expulsion_soon_after_meals and does_not_occur_during_sleep and not_preceded_by_retching and not_explained_by_another_condition_or_eating_disorder and fulfilled_at_least_2_months (Hyams 2016 Rome IV H1c rumination syndrome)",
      "criteria": [
        {
          "factor": "repeated_regurgitation_rechewing_or_expulsion_soon_after_meals",
          "met": true
        },
        {
          "factor": "does_not_occur_during_sleep",
          "met": true
        },
        {
          "factor": "not_preceded_by_retching",
          "met": true
        },
        {
          "factor": "not_explained_by_another_condition_or_eating_disorder",
          "met": true
        },
        {
          "factor": "fulfilled_at_least_2_months",
          "met": true
        }
      ],
      "rome_iv_child_rumination": true
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M",
        "doi": "10.1053/j.gastro.2016.02.015",
        "id": "hyams-2016",
        "pmid": "27144632",
        "source": "Gastroenterology. 2016;150(6):1456-1468",
        "title": "Childhood Functional Gastrointestinal Disorders: Child/Adolescent"
      },
      "formula": "rome_iv_child_rumination",
      "formula_expression": "rome_iv_child_rumination iff repeated_regurgitation_rechewing_or_expulsion_soon_after_meals and does_not_occur_during_sleep and not_preceded_by_retching and not_explained_by_another_condition_or_eating_disorder and fulfilled_at_least_2_months (Hyams 2016 Rome IV H1c rumination syndrome)",
      "criteria": [
        {
          "factor": "repeated_regurgitation_rechewing_or_expulsion_soon_after_meals",
          "met": true
        },
        {
          "factor": "does_not_occur_during_sleep",
          "met": true
        },
        {
          "factor": "not_preceded_by_retching",
          "met": true
        },
        {
          "factor": "not_explained_by_another_condition_or_eating_disorder",
          "met": true
        },
        {
          "factor": "fulfilled_at_least_2_months",
          "met": true
        }
      ],
      "rome_iv_child_rumination": true
    }
  ]
}
```

## Response fields

- `formula` (string): rome_iv_child_rumination
- `formula_expression` (string): Hyams 2016 Rome IV H1c child/adolescent rumination: repeated regurgitation and rechewing or expulsion soon after meals, not during sleep, not preceded by retching, not explained by another condition or eating disorder, and fulfilled at least 2 months
- `rome_iv_child_rumination` (boolean): true only when all five required flags hold. Not a diagnosis.
- `criteria` (array): Per-factor rows with factor and met for the five required flags
- `citation` (object): Hyams 2016 Gastroenterology citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M",
    "doi": "10.1053/j.gastro.2016.02.015",
    "id": "hyams-2016",
    "pmid": "27144632",
    "source": "Gastroenterology. 2016;150(6):1456-1468",
    "title": "Childhood Functional Gastrointestinal Disorders: Child/Adolescent"
  },
  "formula": "rome_iv_child_rumination",
  "formula_expression": "rome_iv_child_rumination iff repeated_regurgitation_rechewing_or_expulsion_soon_after_meals and does_not_occur_during_sleep and not_preceded_by_retching and not_explained_by_another_condition_or_eating_disorder and fulfilled_at_least_2_months (Hyams 2016 Rome IV H1c rumination syndrome)",
  "criteria": [
    {
      "factor": "repeated_regurgitation_rechewing_or_expulsion_soon_after_meals",
      "met": true
    },
    {
      "factor": "does_not_occur_during_sleep",
      "met": true
    },
    {
      "factor": "not_preceded_by_retching",
      "met": true
    },
    {
      "factor": "not_explained_by_another_condition_or_eating_disorder",
      "met": true
    },
    {
      "factor": "fulfilled_at_least_2_months",
      "met": true
    }
  ],
  "rome_iv_child_rumination": true
}
```

## Errors

- HTTP 400 `invalid_rome_iv_child_rumination`: Rome IV child rumination needs the Hyams 2016 child/adolescent H1c flags. Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Rome IV rumination](https://magentlab.com/docs/rome-iv-rumination) — Apply the Stanghellini 2016 Rome IV rumination syndrome (B4) diagnostic criteria and return whether the published rumination box holds (rome_iv_rumination).
- [Rome IV child aerophagia](https://magentlab.com/docs/rome-iv-child-aerophagia) — Apply the Hyams 2016 Rome IV H1d child/adolescent aerophagia diagnostic criteria and return whether the published aerophagia box holds (rome_iv_child_aerophagia).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.