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Sandifer Syndrome

Sandifer Syndrome is a topic covered in the 5-Minute Clinical Consult.

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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


  • Sandifer syndrome is underrecognized.
  • Occurs in <1% of pediatric patients with GERD (1)
  • Most common in male children, although infants and girls can be affected. Adult cases are rare.
  • Commonly misdiagnosed as epilepsy (2)
    • Results in unnecessary medication side effect (2)
    • Does not fix the underlying problem: Long-term sequelae of GERD can still develop (2).

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

  • GERD
  • Male gender (1)
  • Early school-aged children (1)
  • Underlying neurologic disorder

Commonly Associated Conditions

  • Cognitive impairment in older children and adults
  • Hiatal hernia (1)

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Stephens, Mark B., et al., editors. "Sandifer Syndrome." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816083/all/Sandifer_Syndrome.
Sandifer Syndrome. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816083/all/Sandifer_Syndrome. Accessed April 26, 2019.
Sandifer Syndrome. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816083/all/Sandifer_Syndrome
Sandifer Syndrome [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816083/all/Sandifer_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sandifer Syndrome ID - 816083 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816083/all/Sandifer_Syndrome PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -