VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

Sandifer's syndrome was first described in 1964 by Kinsbourne, who reported three cases of this syndrome in children with a hiatal hernia. Surgical treatment of the hernia resolved the symptoms of the syndrome. What is Sandifer's syndrome and how does it manifest itself? What disease entities is it associated with?

Sandifer's syndromeit is more of a symptom than a disease whose etiology, and therefore the causes of its occurrence, are not fully understood. Sandifer's syndrome typically affects infants (i.e. children under 1 year of age) and slightly older, young children. It manifests itself in disturbing, characteristic movements of the baby, reminiscent of a torticollis (turning the baby's head to the left or right). Sometimes the seizures of such movements are confused with an epileptic seizure. Moreover, it is quite typical to bend the spine into an arch, a position known in medicine as opisthotonus. These symptoms typically appear after the baby is fed. Sandifer's syndrome most often occurs in children between the ages of 2.5 and 3.3 years.

Causes of Sandifer's syndrome

As shown in the scientific literature, Sandifer's syndrome is associated with the irritation of the esophagus by acidic gastric contents. This means that we usually deal with such a disease as gastroesophageal reflux disease (GERD). This disease results from the pathological discharge of acid in the stomach into the esophagus. The symptoms of GERD in children include:

  • bronchospastic states,
  • damage to tooth enamel,
  • laryngeal wheezes,
  • ENT problems,
  • sore throat.

Another possible cause of Sandifer's syndrome is a hiatal hernia, a congenital anatomical abnormality in which the hiatus is too large, causing the stomach to invade the chest. The consequence of this defect is the flow of stomach contents back into the esophagus, which causes irritation and the appearance of bending movements (i.e. Sandifer's syndrome).

Sandifer's syndrome - reflex mechanism

Scientists are still debating what is the mechanism of the appearance of flexion movements in children with Sandifer's syndrome. One theory is that the head is tilted and twistedcauses faster cleansing of the esophagus of irritating, acidic gastric contents, which eliminates the duration of unpleasant symptoms.

It is like a defense mechanism against the refluxing contents, irritating the esophageal mucosa, which is not adapted to the acidic contents of the stomach (which we know contains hydrochloric acid).

Another, more recent hypothesis indicates the involvement of the vagus nerve in generating the described movements. According to medical sources, acidic gastric contents can irritate the vagal nerve endings, which causes contractions of the sternoclavicular and trapezius muscles, which is responsible for the movements performed by the child typical of this syndrome. These movements may also be accompanied by the turning of the child's eyeballs upwards, which is also due to the activity of the described vagus nerve.

What symptoms may accompany Sandifer's syndrome?

This syndrome may be accompanied by other symptoms, resulting from irritation of the esophageal mucosa and more. They mainly include:

  • heavy downpour, vomiting,
  • baby's nervousness during feeding, crying, nervousness,
  • refusing to eat, leading to abnormal weight gain and thus - development restriction,
  • recurring infections of the upper respiratory tract,
  • unexplained cough and hoarseness.

Sandifer syndrome diagnosis

If you suspect Sandifer's syndrome, it is worth doing tests that will confirm or exclude the presence of oesophageal reflux. A frequently performed diagnostic test in children is a 24-hour pH-metric test. It requires the insertion of a special probe into the esophagus, which allows you to measure the pH (or acidity) in the esophagus.

This allows you to determine whether acidic food from the stomach enters the esophagus and, importantly, how many such episodes there are in a day and how long they last. Throughout the day when the examination is conducted, parents should write down when the child is fed, what food he eats, as well as the duration and type of complaints or presented by the child.

Treatment of Sandifer's syndrome

Treatment of Sandifer's syndrome consists in treating the conditions that lead to it, i.e. gastroesophageal reflux disease, and sometimes also hiatal hernia.

In the treatment of gastro-oesophageal reflux disease, recommendations include:

  • use of food formulas intended for infants with reflux problems - they are marked with the abbreviation AR - these are concentrated formulas,
  • high-residual and low-fat diet - this is the caseolder children,
  • following certain dietary rules: eating small portions of meals, avoiding eating just before bedtime and before exercise,
  • use of proton pump inhibitors - these are the first-line drugs in the treatment of acid reflux disease. These drugs act by inhibiting the activity of an enzyme in the cells of the gastric mucosa, thanks to which the secretion of hydrochloric acid is reduced and, consequently, the symptoms of the disease are eliminated.

When the cause of Sandifer's syndrome is a hiatal hernia, surgery is usually required, although the decision is ultimately made by the doctor.

Sandifer's syndrome - don't underestimate the symptoms!

Diagnosing Sandifer's syndrome and linking its symptoms to conditions such as esophageal reflux and hiatal hernia is not easy. In many situations, due to the nature of the symptoms, the child first goes to a pediatric neurologist or an ENT specialist.

It is worth being aware of the existence of such a disease entity and when you experience the symptoms described in this article, think about esophageal reflux.

If our children develop any disturbing symptoms during feeding, it is definitely worth consulting with your pediatrician and not underestimating these symptoms.

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Child's he alth