In plain words
Sandifer syndrome is a set of movements seen in some infants with . The baby tilts or twists the head, arches the back, or stretches the neck, often during or after a feed. These movements are thought to be a reaction to acid reaching the lower esophagus. They are not the same as seizures, but they can look alarming. Because the head tilt can resemble , a tight , a mother may hear about a neck problem first. Sandifer syndrome is uncommon compared with ordinary reflux and spit-up. A mother might notice that the tilt happens with feeds, that it eases when the baby is upright, and that spit-up or fussiness is present too. Any new head tilt needs a check by the baby's provider, who will look at the whole picture.
The deeper version
Sandifer syndrome describes paroxysmal dystonic posturing, including torticollis, opisthotonic arching, and dystonic neck extension, in infants with gastroesophageal reflux, most often with esophagitis or hiatal hernia. The first clear descriptions date to the 1960s. The mechanism is thought to be a reflux-triggered dystonic reflex, and the posture is usually transient and resolves when reflux is controlled. The differential for an infant head tilt includes ocular torticollis, congenital muscular torticollis, cervical spine anomalies such as Klippel-Feil syndrome, and neurologic causes, including seizure, which must be excluded. Diagnosis is clinical and is supported in selected cases by upper GI studies or pH-impedance testing. Reported links to hiatal hernia vary across series, and the management focus is the reflux itself.
Where it comes up
- Jaw tension, torticollis, and bodywork for feedingFeeding Your Baby
- Reflux, spit-up, and feedingFeeding Your Baby
What mothers here say about Sandifer syndrome
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Sources
- Kinsbourne M — Hiatus hernia with contortions of the neck. Lancet (1964)
- Rosen R et al. (NASPGHAN) — Management of gastroesophageal reflux in infants and children: NASPGHAN clinical practice guideline. Journal of Pediatric Gastroenterology and Nutrition 2018