Children who are administered pro-motility medications to treat their reflux may experience a side effect called acute dystonic reaction (ADR). Acute dystonic reactions are rigidity and/or spasmodic movements in one or more parts of the body.

The rigid body posturing seen in an ADR may also occur as a result of the reflux itself. Known as Sandifer's syndrome, the abnormal postures are an infant's attempt to find a position that relieves the discomfort caused by the reflux. An important distinction between Sandifer's syndrome and an ADR is that infants with Sandifer's syndrome control their movements, whereas infants experiencing an ADR cannot.

The involuntary spasms and rigidity seen in acute dystonic reactions coupled with the observation that infants may also seem unaware of their surroundings for minutes to hours often leads parents to believe their child is having seizures. The postures seen in Sandifer's syndrome are also often mistaken as seizures.

Consequently, children who have reflux or are being treated with pro-motility drugs may be misdiagnosed as having a seizure disorder and incorrectly be prescribed anti-seizure medications. Some of these medications themselves cause acute dystonic reactions, which often leads to the mistaken assumption that the prescribed dosage is not controlling the seizures. The dosage is increased, the ADR persists, and the cycle continues without controlling the real problem--reflux.

The following animations are an artist's rendering of various types of rigid body posturing babies may exhibit when having acute dystonic reactions to pro-motility drugs. The posture of Sandifer's syndrome is also illustrated.

Disclaimer: These animations are to educate parents about rigid body posturing. As each child is different and these reactions may be present in any combination with varying severity, animations should not be used for the purpose of diagnosis. If you are concerned that your child is having these effects, please see your doctor.

Acute Dystonic Reactions (involuntary movements):
Jaw Dystonia - (Trismus or lockjaw) The jaw is held firmly in place (often seen with lingual dystonia).
Lingual Dystonia - The tongue is protruded (often seen with jaw dystonia).
Oculogyric Crisis - Eyes roll back, the neck is extended, and the eyelids flutter.
Opisthotonus - The entire body is arched backward severely, from the neck down to the ankles.
Torticollis - (Neck Dystonia or wry neck) The head is held, rotated and tilted, to one side.

Other Rigid Body Posturing (voluntary movement):
Sandifer's Syndrome - The neck is extended and body arched back, often involving leg extension.