Sandifer's Syndrome: Causes, Symptoms and Treatments
Sandifer’s syndrome is a movement disorder. In most cases, it affects infants between 18 and 24 months of age. Most often the symptoms disappear on their own before the child is 2 years old.
The main characteristic of Sandifer’s syndrome is the presence of episodes in which the infant turns their neck, arches their back, and throws their head back. This movement is very similar to a seizure. They last between 1 and 3 minutes and may occur up to 10 times a day.
Sandifer’s syndrome is thought to be rare, but this isn’t substantiated as it often goes undiagnosed. The episodes almost always occur during or after the child feeds. Although it may seem like a dangerous episode, it isn’t a dangerous condition for the infant.
The main symptom of Sandifer’s syndrome is the twisting and twisting movement, originated by involuntary muscle contractions. The most characteristic is the arching back. The infant also has jerking and twitching.
During episodes, the infant may suddenly become still, as if they’ve entered another state of mind. The infant stiffens, then relaxes, and then may repeat the cycle several times. The infant may also become irritable and cry.
Other symptoms of Sandifer’s syndrome include the following:
Gurgling sounds or coughing during episodes.
- Trouble sleeping
- Continuous irritability
- Attempting to hold one’s breath
- Slow eating
- Recurrent pneumonia
- Twisted neck or torticollis
- Involuntary and abnormal eye movements
- Limited neck movement
- Pain in the stomach
- Esophagitis or inflammation of the esophagus
- Vomiting blood or hematemesis
- Hiatal hernia
- Feeding difficulties and weight loss
Causes and risk factors
Science doesn’t know the exact cause of Sandifer’s syndrome. However, specialists associate it with the presence of gastroesophageal reflux during digestion. In this condition, food is partially regurgitated and passes from the stomach into the esophagus.
This problem is also common in children with hiatal hernia. In this case, there’s a part of the digestive tract that isn’t in the abdomen but the thorax and protrudes through the diaphragm. Doctors believe that the baby’s spasm may be a way to reduce the pain caused by reflux.
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There’s no evidence that this problem has its origin in the nervous system, although the episodes resemble a seizure. Sometimes Sandifer’s syndrome causes behavioral problems, as the child may be inhibited from eating by the pain that follows.
This also leads to poor feeding and may result in anemia. In such cases, the child may be inactive or listless. Sleep problems may also occur. However, Sandifer’s syndrome isn’t a behavioral problem.
Diagnosis of Sandifer’s syndrome is difficult because symptoms alone aren’t indicative of the disease. Also, some infants have mild symptoms or no signs of reflux at all, so doctors often confuse it with other diseases.
One of the things that makes a difference is whether the episodes occur during or after feeding. If there’s suspicion that this disease is present, it’s common to run some tests such as the following:
- MII or Multichannel Intraluminal Impedance: This allows measuring the flow of solids, liquids, and air in the esophagus. It helps diagnose gastroesophageal reflux.
- PH test: It has the same objective as the previous one.
- Computed tomography: This reveals if there are muscular abnormalities.
- EEG or electroencephalogram: This is performed to observe the electrical activity of the brain and to rule out possible neurological conditions.
Specialists may indicate a record of feeding times. This allows the parent to consider at what time(s) the child eats and determine if this coincides with the presence of the episodes. If so, a diagnosis of Sandifer’s syndrome is likely.
Treatment of Sandifer’s syndrome
Sandifer’s syndrome is associated with gastroesophageal reflux; therefore, treatment focuses on addressing the problem at the source. For this and depending on each case, there may be dietary changes, medications, or surgery.
Suggested dietary and lifestyle changes include the following:
- Give the baby less food, but more frequently.
- Thicken the food with cereal.
- Keeping the baby in an upright position after feeding.
- Having the baby play on his or her stomach, with close supervision, to strengthen the baby’s muscles.
Medications used to treat Sandifer’s syndrome include antacids, histamine H2 antagonists, proton pump inhibitors, and others.
In more severe or resistant cases, a surgery called fundoplication may be necessary to prevent the stomach contents from moving up into the esophagus. If a hiatal hernia is present, surgery may also be recommended. The results are usually very positive.
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Sandifer’s syndrome, a transient condition
Most commonly, the symptoms of Sandifer’s syndrome disappear on their own around 18 months of age. This occurs because the esophageal muscles mature and the gastroesophageal reflux disappears.
Whether spontaneously or by treatment, whenever the reflux disappears, Sandifer’s syndrome also disappears. You should remember that this isn’t a serious condition, but it does cause discomfort and can affect feeding and therefore the baby’s growth.
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- Milman, N. (2012). Fisiopatología e impacto de la deficiencia de hierro y la anemia en las mujeres gestantes y en los recién nacidos/infantes. Revista peruana de ginecología y obstetricia, 58(4), 293-312.
- Gonçalves, E. S., de Assumpção, M. S., Servidoni, M. F. C. P., Lomazi, E. A., & Ribeiro, J. D. (2020). Multichannel intraluminal impedance‐pH and psychometric properties in gastroesophageal reflux: systematic review. Jornal de Pediatria (Versão em Português), 96(6), 673-685.
- Quintero, M. I., López, K., Belandria, K., & Navarro, D. (2012). Sindrome de Sandifer: A propósito de la enfermedad por reflujo gastroesofágico en niños. Gen, 66(2), 133-135.