Sandifer Syndrome In Babies: Causes, Symptoms And Treatment

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Sandifer syndrome in babies is a rare gastrointestinal disorder associated with gastroesophageal reflux (GER) and other symptoms such as abnormal movements of the head, neck, and upper part of the trunk (1). These unusual neck movements may be misdiagnosed as an epileptic seizure. However, it is not a neurological condition, and it is usually self-resolves as the baby grows in age. Read the post to know more about the symptoms, causes, diagnosis, and treatment of Sandifer syndrome in babies.

How Common Is Sandifer Syndrome?

According to the US National Institutes of Health, the exact prevalence of Sandifer syndrome is unknown, but the condition is considered rare (2). The onset of the syndrome usually occurs during infancy or early childhood. Sandifer or Sandifer’s syndrome has a good prognosis despite it being an uncommon ailment.

What Are The Symptoms Of Sandifer Syndrome?

Torticollis and dystonia are the main characteristic symptoms of Sandifer’s syndrome in babies. Torticollis is characterized by a sideward tilt of the head with a chin rotation toward the opposite side of the tilt (3).

Dystonia is characterized by repetitive and patterned muscle contractions that cause twisting of the torso and abnormal posturing (4).

The following are other commonly seen symptoms in babies with Sandifer’s syndrome. These symptoms usually exacerbate after feeding (2) (5) (6).

  • Nodding and rotation of the head
  • Neck extension
  • Gurgling sounds
  • Writhing movement of limbs
  • Weakness of muscles
  • Arching of the spine
  • Upward deviation of eyes
  • Vomiting
  • Reduced appetite
  • Anemia
  • Stomach ache
  • Vomiting blood
  • Symptoms that stop while sleeping

A baby can show bouts of symptoms. Each episode may last for one to three minutes and might occur up to ten times a day (2). Consult a doctor if your baby displays any of the above symptoms.

Causes Of Sandifer Syndrome In Babies

Researchers have not been able to pinpoint the specific cause of Sandifer syndrome in babies. However, gastroesophageal reflux is often attributed as the cause of Sandifer’s syndrome (7). Acid reflux causes a lot of discomfort and pain, and the jerky movements occur as a response to the pain (8).

Gastroesophageal reflux happens due to problematic lower esophageal sphincter, which is a muscle that lies at the lower end of the esophagus (food pipe), and beginning of the stomach. In GER, the muscle of the sphincter relaxes more than usual, thus causing stomach acid and gastric juices to flow into the food pipe and towards the mouth. (9) (10).

How To Diagnose Sandifer Syndrome?

The symptoms of Sandifer syndrome often appear similar to epileptic convulsions, infantile spasms, or paroxysmal dystonia (2). Therefore, most doctors perform neurological assessments to rule any such ailments.

The doctor also checks for a history of gastroesophageal reflux (GER). Esophageal endoscopy and pH monitoring might help detect the presence of gastric acid in the upper esophagus, but is rarely necassary (11).

Upper esophageal endoscopy is a principle method to evaluate the mucosa of the esophagus to check for complications of GER (7). Esophageal pH monitoring is done over a period of 24 hours to determine the quantity of acid reflux (7).

The doctor will recommend these procedures only if necessary since they might require overnight hospitalization. The presence of GER, along with torticollis and dystonia, points towards Sandifer’s syndrome.

Treatment Of Sandifer Syndrome In Babies

If the doctor suspects Sandifer’s syndrome, then they might recommend some dietary changes to stop the acid reflux. The following are the other various changes that might be suggested by your pediatrician to manage GER and Sandifer’s syndrome (12).

  • Avoid overfeeding the baby
  • Keep the baby upright for half an hour after feeding
  • Cow milk products should be avoided by breastfeeding mothers, only if cow milk allergy is suspected
  • Switch to extensively hydrolyzed protein or amino acid-based formula if an allergy is suspected
  • Add rice cereal to the formula as a thickening agent
  • In some cases, an anti-reflux (thickened) formula might be advised
  • Do not expose the baby to second-hand tobacco smoke

If making these changes does not help, the doctor might recommend the following acid suppression medications (13).

  • H2 receptor blockers like cimetidine, famotidine, nizatidine or ranitidine (13) (14)
  • Proton pump inhibitors like esomeprazole (15)

Very rarely, when none of these works, the doctor might recommend surgical intervention. The procedure is known as Nissen fundoplication. In this procedure, a part of the upper stomach is wrapped around the lower part of the esophagus to create a tight nipple valve that stops the reflux (16).

The treatment plan should be decided by the baby’s pediatrician. Do not give any OTC medications without consulting the doctor.

Frequently Asked Questions

1. Is Sandifer syndrome hereditary?

Sandifer’s syndrome is a result of GER. GER is said to have a genetic predisposition. (17). Inheritance to GER could also lead to the inheritance of Sandifer’s syndrome. However, more research needs to be done to establish a correlation.

2. Is Sandifer syndrome related to autism in babies?

Babies with autism spectrum disorders are at a higher risk for gastrointestinal disorders than babies with typical development. Increased gastroesophageal reflux might lead to an increased risk of Sandifer’s syndrome in babies with autism. However, some behaviors assumed to be of autism might actually be caused by GERD (18). Therefore, do not assume that your baby has autism because of the jerky body movements. If you have any concerns, then consult your pediatrician to diagnose the cause.

3. Do babies grow out of Sandifer syndrome?

The main cause of Sandifer’s syndrome is acid reflux. Acid reflux tends to reduce as the babies grow in age and the muscles of the esophagus become more developed. Many babies tend to outgrow the spasms later in childhood (19).

Sandifer Syndrome in babies is a rare condition involving gastroesophageal reflux, sideward head tilt, and jerky movements in the upper parts of the body. Diagnosis is based on ruling out other neurological disorders that may cause muscle spasms. The condition is manageable, and babies may outgrow the disease with time. However, you may take steps to prevent acid reflux and look out for possible food allergies and intolerances. Consult your pediatrician if you suspect Sandifer’s syndrome in your baby, and avoid using over-the-counter medications to provide relief.

References:

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1. Sandifer’s syndrome in a breast-fed infant; The American Journal of Perinatology
2. Sandifer syndrome; U.S. Department of Health & Human Services
3. Torticollis in infants and children: common and unusual causes; ResearchGate
4. Fernández-Alvarez E, Nardocci N, Update on pediatric dystonias: etiology, epidemiology, and management; The Journal of Degenerative Neurological and Neuromuscular Diseases
5. DEMETRIOS S THEODOROPOULOS, RICHARD F LOCKEY, Sandifer’s syndrome and gastro- oesophageal reflux disease; The Journal of Neurology, Neurosurgery & Psychiatry
6. Burcin Nalbantoglu, Donma M. Metin, and Ayşin Nalbantoglu, Sandifer’s Syndrome: a Misdiagnosed and Mysterious Disorder; The Iranian Journal of Pediatrics
7. DREW C. BAIRD et al, Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children; American Family Physician
8. ANDREW D. JUNG, Gastroesophageal Reflux in Infants and Children; American Family Physician
9. Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs; American Academy of Pediatrics
10. Hiatal Hernia (Pediatric); Washington University School of Medicine in St. Louis
11. Natasha Bamji et al, Treatment of Sandifer Syndrome with an Amino-Acid–Based Formula; The American Journal of Perinatology
12. Sandifer Syndrome Treatment & Management; Medscape
13. J Bhatia and A Parish, GERD or not GERD: the fussy infant; The Journal of Perinatology
14. Sandifer Syndrome Medication; Medscape
15. Sandifer Syndrome Medication; Medscape
16. NISSEN FUNDOPLICATION; Children’s Minnesota
17. Reflux – Gord and Gerd; Birth-defect Organization
18. Virginia Chaidez, Robin L. Hansen, and Irva Hertz-Picciotto, Gastrointestinal problems in children with autism, developmental delays or typical development; US National Library of Medicine
19. What is the prognosis of Sandifer syndrome?; Medscape
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Dr. Wayne Hough

(MBChB, MMed, FC Paeds)
Dr. Wayne Hough is a pediatrician currently based in the Northern Suburbs of Cape Town in South Africa. He got his medical degree from the University of Stellenbosch. He then worked at the Tygerberg Children's Hospital before completing his pediatric training and qualification from the South African College of Medicine. Dr. Hough also holds a MMed degree in pediatrics from... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more