Sandifer’s Syndrome: Causes, Symptoms And Treatments

Sandifer’s syndrome is not considered a serious condition, and most cases resolve on their own. However, it causes symptoms that affect the infant’s feeding and development that must be considered.
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. Most often, the symptoms disappear by themselves before the child is 2 years old.

The main characteristic of Sandifer’s syndrome is the presence of episodes in which the infant turns its neck, arches its back and throws its head backwards. This movement is very similar to a seizure. They last between 1 and 3 minutes and can occur up to 10 times a day.

Sandifer’s syndrome is believed to be rare, but this is not substantiated as it is often undiagnosed. The episodes almost always occur during or after the baby is fed. Although it may seem like a dangerous episode, it is not a dangerous condition for the infant.

Related symptoms

A baby crying because of Sandifer's syndrome
Sandifer’s syndrome is characterized by an involuntary twist.

The main symptom of Sandifer’s syndrome is twisting, which is due to involuntary muscle contractions. The most characteristic is the curved back. The infant also has twitches.

During episodes, the child may suddenly become quiet, as if he has entered another state of mind. The child stiffens, relaxes and can then repeat the cycle several times. The child may also become irritated and cry.

Other symptoms of Sandifer’s syndrome include the following:

Gargling sounds or coughing during episodes.

  • Sleep problems
  • Continuous irritability
  • Suffocation
  • Try to hold your breath
  • Slow eating
  • Recurrent pneumonia
  • Twisted neck or torticollis
  • Involuntary and abnormal eye movements
  • Anemia
  • Limited neck movement
  • Stomach pain
  • Inflammation of the esophagus
  • Vomiting of blood or hematemesis
  • Vomiting
  • Hiatal hernia
  • Eating difficulties and weight loss

Causes and risk factors

Science does not know the exact cause of Sandifer’s syndrome. However, specialists associate it with the presence of gastroesophageal reflux during digestion. In this condition, the food is partially regurgitated and goes from the stomach to the esophagus.

This problem is also common in children with hiatal hernia. In this case, it is a part of the digestive tract that is not in the stomach, but the chest and protrudes through the membrane. Doctors believe that the baby’s cramp may be a way to reduce the pain caused by reflux.

There is no evidence that this problem originates in the nervous system, although the episodes resemble a seizure. Sometimes Sandifer’s syndrome causes behavioral problems, as the child may have difficulty eating due to the pain that follows.

This also leads to poor feeding and can lead to anemia. In such cases, the child may be inactive or lethargic. Sleep problems can also occur. However, Sandifer’s syndrome is not a behavioral problem.

Diagnostic tests

Diagnosis of Sandifer’s syndrome is difficult because the symptoms alone are not signs of the disease. Some infants also 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 it is suspected that this disease is present, it is common to run some tests such as the following:

  • MII or multi-channel intraluminal impedance : This makes it possible to measure the flow of solids, liquids and air in the esophagus. It helps in diagnosing gastroesophageal reflux.
  • PH test : It has the same dimensions 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 can request a registration of feeding times. This allows the parent to find out at what time the child eats, and if this coincides with the presence of the episodes. In that case, a diagnosis of Sandifer’s syndrome is likely.

Treatment of Sandifer’s syndrome

A baby with Sandifer's syndrome who eats a strawberry
Sandifer’s syndrome is often associated with gastroesophageal reflux.

Sandifer’s syndrome is associated with gastroesophageal reflux; therefore, treatment focuses on solving the problem at source. For this and depending on each case there may be dietary changes, medications or surgery.

Suggested dietary changes include the following:

  • Give your child less food, but more often.
  • Thicken the food with grains.
  • Keep the baby in an upright position after feeding.
  • Have the baby play on his stomach, under 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, an operation called fundoplication may be necessary to prevent the stomach contents from moving up into the esophagus. If there is a hiatal hernia, surgery may also be recommended. The results are usually very positive.

Sandifer’s syndrome, a transient condition

Usually, the symptoms of Sandifer’s syndrome go away on their own around the age of 18 months. This happens because esophageal muscles mature and gastroesophageal reflux disappears.

Whether spontaneous or treatment, when the reflux disappears, Sandifer’s syndrome also disappears. You should remember that this is not a serious condition, but it causes discomfort and can affect feeding and thus the baby’s growth.

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