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Sandifer Syndrome

Feba Thomas, MD, MS and Swati Avashia, MD, FAAP, FACP, ABIHM Reviewed 06/2018
 


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 tempora...

DIAGNOSIS

HISTORY

History is the most important aspect of diagnosing Sandifer syndrome. 
  • Abnormal movements 30 minutes after feeding

  • Poor feeding (1)

  • Vomiting (1)

  • No mental status changes

  • No postictal depre...

TREATMENT

MEDICATION

First Line

Proton pump inhibitors (PPI) (5)[C
  • Omeprazole

    • 1 month to 1 year: 0.7 mg/kg/day PO

    • 1 to 16 years: 5 to <10 kg (5 mg/day PO), 10 to ≤20 kg (10 mg/day PO), >20 kg (20 m...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

If symptoms do not resolve with treatment of GERD, refer to a neurologist for video-EEG to look for seizures (5). 

PROGNOSIS

Sandifer syndrome resolves once the GER...

REFERENCES

1
Cafarotti A, Bascietto C, Salvatore R, et al. A 6-month-old boy with uncontrollable dystonic posture of the neck. Pediatr Ann.  2014;43(1):17–19. [View Abstract on OvidMedline]
2
Kabaku...

CODES

ICD10

M43.6 Torticollis 

ICD9

723.5 Torticollis, unspecified 

SNOMED

230314007 Sandifer syndrome 

CLINICAL PEARLS

  • Sandifer syndrome is underrecognized and often misdiagnosed as epilepsy.

  • History is the most important aspect of diagnosing Sandifer syndrome.

  • Sandifer syndrome is commonly associated wi...

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