What Is Sandifer Syndrome?

Written by Alyssa Anderson
Medically Reviewed by Dan Brennan, MD on February 20, 2024
3 min read

Sandifer syndrome is a type of movement disorder that’s associated with acid reflux and—sometimes—a type of stomach hernia. Movements can range from arching in your back to tense neck postures. They usually happen right after eating. 

Sandifer syndrome was first recorded in the early 1960s, and the exact number of cases is unknown. It’s most often seen in infants and young children but can also occur in teenagers and adults.  

It’s a rare disorder that’s found in less than 1% of cases of a related condition called gastroesophageal reflux disease (GERD). 

Since Sandifer syndrome is seen in GERD patients, researchers weren’t sure at first if the neck and back spasms were causing the reflux or if the reflux was causing the back spasms. Current research indicates the latter— that the movements are your body’s attempt to relieve the pain from the stomach acid. 

The neck and back movements that characterize Sandifer syndrome always seem to occur when the person’s throat is acidic from a lot of reflux.

Some links have also been observed between allergies to cow’s milk and Sandifer syndrome. 

Symptoms of Sandifer syndrome include:

  • Dystonic movement of the neck and back. These are involuntary muscle spasms that lead to repetitive and twisting movements. The spine can arch, bending your head toward your feet and twisting your neck to one side.
  • Acid reflux. This is when stomach acid travels up your esophagus and throat and causes pain and damage.
  • Hiatal hernias. This is when the upper part of your stomach bulges into your diaphragm. 
  • Vomiting. This is typically associated with the same conditions that lead to acid reflux.
  • Anemia. This condition occurs when your red blood cell count is low. 
  • Malnutrition. Severe reflux can make it hard to eat, and you may not get enough nutrients. 
  • Rumination. This occurs when you spit up your food and need to rechew and swallow it. 
  • Abnormal eye movements. 

Episodes of the involuntary muscle spasms and reflux usually last between 1 and 3 minutes. They can happen more than ten times a day. 

The symptoms of Sandifer syndrome are often misdiagnosed as other conditions, including: 

  • Infant spasms
  • Epilepsy
  • Seizures from an unknown neurological condition
  • Dystonia, a condition where the muscles spasm in a similar way 

These misdiagnoses can be problematic because they can lead to a lot of unnecessary tests on your infant, including MRIs and other imaging procedures.

If your doctor misdiagnoses the condition as epilepsy, you run the risk of giving your child unneeded medications. These medications can have their own complications. 

The main treatment for Sandifer syndrome is to make some easy lifestyle changes. In 80% of infants, there’s improvement in their symptoms after just two weeks of making these adjustments: 

  • Exclusionary diets. Allergies to cow’s milk seem to make symptoms worse. It’s best to exclude cow’s milk from your baby's diet or from your own diet if you’re breastfeeding. You may also need to change to a different kind of formula if yours is increasing episodes of reflux. 
  • Adjusting food. You can thicken formula by adding plain infant rice cereal at a ratio of anywhere from one teaspoon to one tablespoon of cereal per ounce of formula. This will help calm your baby’s stomach and reduce reflux. 
  • Posturing changes. Always pay attention to your baby’s—and your own—head after feeding. Keeping the head upright is the best way to reduce reflux. It can also help to put your baby on their belly to ease reflux. You should only do this when your baby is alert and supervised, though. Otherwise, you risk sudden infant death syndrome (SIDS).
  • Medications. There’s no research about using medicine on children younger than 12 months old, but antacids and acid suppressants—like proton pump inhibitors—can help reduce symptoms in older children and adults. 

In very rare cases, a surgery—called a fundoplication—will be required to treat this condition. This is only when the symptoms are severe and don’t respond to any other kinds of treatment. The surgery involves tying the stomach around the lower part of the esophagus to reduce the amount of reflux. 

Sandifer syndrome isn’t a serious condition. It typically clears up by age 2, and it isn’t associated with any long-term complications.  The most serious long-term effect could be problems from malnutrition if the condition is severe and never treated.