Sandifer Syndrome is a condition that presents with unusual physical manifestations, often observed in infants and young children, typically associated with an underlying digestive issue. This article will clarify what Sandifer Syndrome is, detail its key indicators, explain how it is diagnosed, and outline common treatment approaches.
Defining Sandifer Syndrome
Sandifer Syndrome is characterized by temporary, involuntary movements linked to gastroesophageal reflux disease (GERD). It is not considered a primary neurological disorder, but rather a response to the discomfort caused by the backflow of stomach contents into the esophagus. The movements, which can include arching of the back and twisting of the neck, are typically paroxysmal, meaning they occur in sudden, brief episodes. Infants and young children instinctively contort their bodies in an attempt to alleviate the pain from acid reflux. While the exact mechanism for these specific movements is not fully understood, they are consistently associated with the presence of GERD.
Key Indicators and Symptoms
The characteristic movements of Sandifer Syndrome often involve the head, neck, and back. Infants may exhibit arching of the back or stiffening of the body. Head tilting and twisting of the neck are also common. These episodes are typically brief, lasting a minute or two, and occur frequently, often immediately after feeding. Importantly, these movements are usually absent during sleep, which helps distinguish them from seizure activity. Infants with Sandifer Syndrome often display other symptoms associated with GERD. These can include excessive fussiness, irritability, and prolonged crying, especially during or after meals. Visible signs of reflux such as frequent spitting up, vomiting, gagging, or choking may also be present. Persistent feeding difficulties or poor weight gain can indicate ongoing discomfort from the underlying reflux.
Confirming a Diagnosis
Diagnosing Sandifer Syndrome typically begins with a comprehensive medical history and a physical examination by a healthcare professional. Observing the characteristic movements and noting their timing in relation to feeding are important steps. Because the movements can resemble seizures, ruling out other neurological conditions is a key part of the diagnostic process. Confirming the presence of underlying gastroesophageal reflux disease is central to the diagnosis. While specific tests are not always required if the clinical picture is clear, some cases may involve specialized investigations. A pH monitoring study, which measures acid levels in the esophagus over time, can help confirm the presence and severity of GERD.
Treatment Approaches
Managing Sandifer Syndrome primarily focuses on treating the underlying gastroesophageal reflux disease. Initial interventions often involve non-pharmacological strategies aimed at reducing reflux symptoms. These can include modifying feeding practices, such as thickening formula or breast milk with rice cereal, and ensuring the infant remains in an upright position during and after feeds. Adjustments to feeding volume and frequency may also be recommended. If lifestyle changes are insufficient, medications to reduce stomach acid production may be prescribed.
Prognosis
The prognosis for infants with Sandifer Syndrome is generally excellent. The condition typically resolves as the child matures and the lower esophageal sphincter, which controls the flow between the esophagus and stomach, strengthens. Most cases resolve by 12 to 24 months of age, and long-term complications are rare.