Sandifer Syndrome Clinical Presentation

Updated: Apr 10, 2020
  • Author: Pegeen Eslami, MD; Chief Editor: Carmen Cuffari, MD  more...
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Sandifer syndrome is most commonly mistaken for seizures. [3, 4, 6, 11] The infant or child typically appears to have an alteration in mental status associated with the tonic posturing.

A relationship with feeding suggests the diagnosis of Sandifer syndrome, which commonly occurs after feeding.

Posturing is typically brief, temporally associated with feeding, paroxysmal, and absent during sleep. The child may have a sudden deviation of the head and neck to one side and the legs to the opposite side with a stretched-out appearance. Typically, the back is arched posteriorly with hyperextension of the spine, and elbows may be flexed and held posteriorly with hyperextended hips. Torticollis may be present. [3, 6, 11, 12]

Although the intermittent stiff tonic posture and periods of crying and apparent discomfort may suggest seizures, in many cases the rhythmic clonic component, which may be present in seizures, is not described.

Various stiff, bizarre postures can be observed, with the following features noted:

  • Typically, the duration of the posture is 1-3 minutes.
  • This brief, paroxysmal pattern of posturing accounts for the fact that the movement observed in Sandifer syndrome may be mistaken for seizures.
  • During the posture, the infant may become very quiet or, less commonly, become very fussy. Fussiness and evident discomfort are most commonly observed as the posture abates
  • If a significant volume of gastroesophageal reflux is observed, even without actual vomitus, some infants and children may exhibit evidence of respiratory tract irritation as well, including cough, wheezing, and stridor, depending on the degree and volume of reflux. [13]

Physical Examination

In children with Sandifer syndrome without mental impairment, the physical examination findings are normal. Children with Sandifer syndrome with mental impairment may have evidence of spasticity and may receive a diagnosis of cerebral palsy. [14]

Sandifer syndrome in infants is most commonly associated with normal physical examination findings. In older children, the syndrome may be associated with mental impairment or anatomic abnormalities of the gastrointestinal tract, such as hiatal hernia.

In infants with significant gastroesophageal reflux disease or unsuspected milk protein allergy, the physical examination may reveal evidence of poor nutrition, poor weight gain, and occult blood on fecal guaiac testing.