Sandifer Syndrome

What is Sandifer syndrome?

Sandifer syndrome is a condition characterized by unusual movements of your child’s head, neck and back. The condition can cause temporary muscle spasms as a reaction to acid reflux. Symptoms are most common after your baby eats when the contents of their stomach don’t settle.

Who does Sandifer syndrome affect?

Sandifer syndrome typically affects infants and young children, as well as those with developmental delays.

How common is Sandifer syndrome?

Studies show that nearly 7% of infants in the United States have gastroesophageal reflux disease (GERD) and less than 1% of those infants experience muscle spasms.

How does Sandifer syndrome affect my baby?

You’ll most likely see symptoms of Sandifer syndrome in your baby after they eat. This happens because their body reacts to the stomach contents moving in the wrong direction up into their food pipe (esophagus). Similar to how you might feel heartburn after you eat something spicy, your baby feels that sensation while drinking breast milk (chest milk) or formula. Their body reacts with involuntary spasms to help them ease the discomfort.

What are the symptoms of Sandifer syndrome?

Symptoms of Sandifer syndrome include:

• Gastroesophageal reflux disease (GERD): GERD, also known as acid reflux, occurs when the contents in your child’s stomach (stomach acid) flow back into the food pipe (esophagus). When this happens, your child could spit up, feel a burning sensation in their chest (heartburn), chest pain or have a sour taste in their mouth.
• Dystonic movements: Dystonic movements, or muscle spasms, are involuntary movements of your baby’s muscles that cause repetitive, irregular twisting of their body like arching their back, tremors, rapid blinking, neck rolling and tight muscles.
• Feeding difficulties: Your baby could experience several signs of discomfort while feeding, which could include crying, fussiness or gagging.

Additional symptoms that can happen as a result of Sandifer syndrome include:

• Anemia.
• Weight loss.
• Stridor and/or wheezing.
• Bulge of the upper stomach (hiatal hernia).

What causes Sandifer syndrome?

The exact cause of Sandifer syndrome is unknown. Studies suggest that an underdeveloped connection between the food pipe (esophagus) and the stomach in infants allows the stomach’s contents to flow back into the food pipe, which can lead to gastroesophageal reflux disease (GERD), but research is ongoing to learn more.

Your baby reacts to feeling pain or discomfort caused by GERD with dystonic movements or muscle spasms. When your baby quickly jerks their body or arches their back, they’re fighting the internal movement of the contents of their stomach and esophagus going in the wrong direction. This quick movement is similar to how you pull your hand away from a hot surface to avoid burning your hand.

How is Sandifer syndrome diagnosed?

Your baby’s provider will diagnose Sandifer syndrome after taking a complete medical history and performing a physical exam to learn more about your child’s symptoms. Tests aren’t usually necessary, but they can rule out conditions with similar symptoms to confirm a diagnosis. Tests might include:

• Endoscopy: Your baby’s provider will use a camera to look inside their stomach and esophagus.
• Esophagram (barium swallow): X-ray images of your child’s esophagus, taken while they swallow, can show their esophagus in action.
• Electroencephalogram (EEG): This test tracks the electrical activity in your baby’s brain to rule out conditions like epilepsy, which can have symptoms similar to those of Sandifer syndrome.

How is Sandifer syndrome treated?

Managing GERD is the key to treating Sandifer syndrome. There are two ways to do that: dietary changes or taking medications.

Dietary changes

The first option your provider might recommend is thickening your baby’s diet by adding 1 teaspoon of rice cereal or other thickener per ounce of formula or breast milk (chest milk). Your baby’s provider will help you identify how often and how much your baby should take in each day. During their feeding and right after, it’s important that your baby sits upright, or someone holds them in an upright position, to help prevent food from coming back up. It’s also important to burp your baby during and right after feeding to bring up any air they may have swallowed.

Some infants diagnosed with Sandifer syndrome have an allergy to proteins in cow’s milk or certain types of formulas, which can make their symptoms worse. In these situations, breastfeeding (chestfeeding) parents may have to change their diets or use a different formula as your baby’s provider recommends.

Medications

If changes to your baby’s diet don’t work, your provider may recommend treatment with anti-reflux medications, including:

• Proton pump inhibitors.
• H2 blockers.

After anti-reflux medications start, you should notice your baby’s symptoms decrease over time and resolve.

If your child has a hernia, surgery could be an option if medications don’t work to treat symptoms.

How soon after treatment will my baby feel better?

After treatment begins, your baby’s symptoms should decrease or resolve over time. This could take a few weeks to a month. During treatment, your baby’s provider will monitor how they respond to dietary changes or medications to make sure your child is healthy and thriving.

How can I prevent Sandifer syndrome?

While you can’t prevent all causes of the condition, you can do the following to reduce your baby’s risk of developing Sandifer syndrome:

• Feed your baby small meals more often throughout the day.
• Thicken your baby’s food with cereal.
• Keep your baby upright as they eat.
• Burp your baby during and right after feeding.

If your baby has gastroesophageal reflux disease, follow your provider’s recommended treatment plan to make sure your baby’s symptoms improve and that they get the nutrients they need to stay healthy.

What can I expect if my baby has Sandifer syndrome?

Sandifer syndrome is a temporary condition that usually goes away or clears up by the time your baby reaches one year old. Treatment with dietary changes or medications helps reduce symptoms to help the condition go away faster. If your baby doesn’t receive treatment and has trouble eating, they could experience long-term symptoms throughout childhood as a result of malnutrition, but this is rare.

When should I see my healthcare provider?

Visit your baby’s healthcare provider if they:

• Can’t eat or keep food down.
• Are losing weight.
• Have worsening symptoms or more muscle spasms than normal after treatment begins.

What questions should I ask my doctor?

• How much and how often should I feed my baby?
• What type of thickener should I use to thicken breast milk/formula?
• Does my baby have any food allergies?
• Are there side effects to the anti-reflux medications?

A note from Cleveland Clinic

It can be upsetting to see your baby have muscle spasms or not eat regularly because of reflux. It’s important that you see your baby’s provider when they start showing symptoms of Sandifer syndrome to prevent malnutrition and ease your baby’s discomfort. The condition usually clears up by the time your baby reaches 1 year old or sooner with treatment that your baby’s healthcare provider recommends.