When Breastfeeding Transfers More Than Milk: A Case of Infant Dystonia

Alizadeh, Anahita; Pourbadakhshan, Nafiseh; Shokrgozar, Motahare

doi:10.22038/jpp.2026.96603.5684

When Breastfeeding Transfers More Than Milk: A Case of Infant Dystonia

Document Type : case report

Authors

Anahita Alizadeh ¹

Nafiseh Pourbadakhshan ²

Motahare Shokrgozar ³

¹ Department of Clinical Toxicology, MTRC (Medical Toxicology Research Center), Mashhad University of Medical Sciences, Mashhad, Iran.

² Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/jpp.2026.96603.5684

Abstract

Background: Acute Drug-Induced Dystonia is a common type of extrapyramidal movement disorder. This condition is characterized by involuntary and sustained contractions of skeletal muscles, which can lead to abnormal postures such as torticollis, oculogyric crisis, facial spasm, laryngospasm, and opisthotonus.
Case Presentation: A 6-month-old female infant was brought to the pediatric emergency department by her parents due to the sudden onset of neck deviation to the right (torticollis) since the morning of admission. The parents stated that the child woke up with her head in an abnormal position and was unable to return it to the central position. The medication history revealed that the mother had received a single dose of intravenous metoclopramide the night before at a medical center due to nausea and vomiting. The infant herself had not received any other medications. Neurological examination showed no focal signs, meningeal stiffness, signs of increased intracranial pressure, or other involuntary movements. The patient received a single dose of biperiden 0.04 mg/kg intramuscularly. Reports from parents and the treatment team indicated that within minutes, the neck deviation was completely corrected, and the infant regained the ability to move their head freely. No recurrence of symptoms was reported during 6 hours of emergency monitoring.
Conclusion: This report shows that 1) Acute drug-induced dystonia should be one of the primary diagnoses in sudden torticollis in infants. 2) Taking a detailed drug history is very important.3- Rapid diagnosis and initiation of anticholinergic treatment lead to complete recovery and prevent unnecessary invasive procedures.

Keywords

Drug-Induced Dystonia

Infant

Metoclopramide

Torticollis

1. Lau Moon Lin M, Robinson PD, Flank J, Sung L, Dupuis LL. The safety of metoclopramide in children: a systematic review and meta-analysis. Drug safety. 2016 Jul;39(7):675-87.

2. Rodnitzky RL. Drug-induced movement disorders in children. InSeminars in Pediatric Neurology 2003 Mar 1 (Vol. 10, No. 1, pp. 80-87). WB Saunders.

3. Dudipala SC, Prashanthi M, Ch LK. Clinical profile of acute drug-induced dystonia in children. Indian Journal of Child Health. 2020 May 26;7(5):220-2.

4. Van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. Bmj. 1999 Sep 4;319(7210):623-6.

5. Park HW, Kwak JR, Lee JS. Clinical characteristics of acute drug-induced dystonia in pediatric patients. Clinical and Experimental Emergency Medicine. 2017 Sep 30;4(3):133.

6. Yarar C, Yakut A, Carman KB, Sahin S, Kocak O, Ozkan S, et al. Metoclopramide-induced acute dystonia: data from a pediatric emergency unit. Pediatric emergency care. 2021 Sep 1;37(9):e528-33.

7. Menikarachchi L, Jayantha M. Text Mining Analysis of Metoclopramide Reviews: Adverse Effects, Patients’ Perspectives and Off-label Use. Sri Lankan Journal of Health Sciences. 2022 Dec 31;1(2).

8. Fransisca TB, Nanda D, Khoirunnisa R, Leksono AD, Maliha AR, Salsabila NS, et al. Comparison of The Effectiveness of Ondansetron and Metoclopramide in Nausea and Vomiting: Literature Review. Menara Journal of Health Science. 2025 Dec 25;4(4):368-83.

9. Hoffman RJ, Nillas A. Toxidromes and a general approach to poisoning. Archives of disease in childhood. 2025 Sep 1;110(9):681-6.

10. Bateman DN, Rawlins MD, Simpson JM. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed). 1985 Oct 5;291(6500):930-2.

11. Garone G, Graziola F, Grasso M, Capuano A. Acute movement disorders in childhood. Journal of Clinical Medicine. 2021 Jun 17;10(12):2671.

12. Kulkarni SD, Kothari SR. Pediatric movement disorders and neuromodulation: An overview. Neurology India. 2020 Nov 1;68(Suppl 2):S206-12.

13. Panda PK, Panda P. Nelson Textbook of Pediatrics 22nd International Edition.

14. Rissardo JP, Vora N, Mathew B, Kashyap V, Muhammad S, Fornari Caprara AL. Overview of movement disorders secondary to drugs. Clinics and Practice. 2023 Aug 18;13(4):959-76.

15. Hammami H, Jeddi C, Kilani M, Thabet H. Acute drug-induced dystonia: Emergency department presentation and management. Toxicologie Analytique et Clinique. 2025 Sep 2.

16. Gorodetsky C, Fasano A. Approach to the treatment of pediatric dystonia. Dystonia. 2022 Aug 2;1:10287.

17. Cui L, Guo D, Zhu M, Wang T, Gao A, Xiao J. Incidence, clinical characteristics and related drugs analyzing of drug-induced movement disorders in 102914 inpatients: a retrospective real-world study. Expert Opinion on Drug Safety. 2025 May 5:1-9.

18. Tran H, Sun D. New Advances in US FDA Approved Oncology Drugs from 2015-2023. American Journal of Pharmaceutical Education. 2024 Sep 1;88(9).