Sandifer Syndrome
Basics
Description
Sandifer syndrome is defined by abnormal neurobehavioral movements in the context of hiatal hernia or gastroesophageal reflux disease (GERD) (1).
- Abnormal movements are often temporally associated with feedings and include the following:
- Irritability/crying
- Head/eye version
- Torticollis
- Extensor spasm
- Dystonic posturing
- Apnea
- Minimal jerking of the extremities
Epidemiology
Etiology and Pathophysiology
Movements are hypothesized to be a vagally mediated reflex response to esophageal acid exposure (3). The eosinophilic esophagitis from cow’s milk protein allergy may also be a cause of Sandifer syndrome (4).
Risk Factors
Commonly Associated Conditions
- Cognitive impairment in older children and adults
- Hiatal hernia (1)
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Citation
Domino, Frank J., et al., editors. "Sandifer Syndrome." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688667/all/Sandifer_Syndrome.
Sandifer Syndrome. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688667/all/Sandifer_Syndrome. Accessed October 15, 2024.
Sandifer Syndrome. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688667/all/Sandifer_Syndrome
Sandifer Syndrome [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 15]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688667/all/Sandifer_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Sandifer Syndrome
ID - 1688667
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688667/all/Sandifer_Syndrome
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -