What are the signs and symptoms of Sandifer syndrome?

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. [4, 3, 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. [12, 3, 6, 11]  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 is 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 manifest evidence of respiratory tract irritation as well, including cough, wheezing, and stridor, depending on the degree and volume of reflux. [13]

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