Newborn Jitteriness, Twitching and Seizures

Is Jitteriness in Newborn Babies Abnormal?

Jitteriness refers to tremors in newborns. It is the representation of an exaggerated startle response. Tremulousness is often confused for seizures (also known as convulsion and fits), which naturally unnerves the parents.

It is the most common involuntary movement seen in infants, which disappears completely as they mature. The neuro-development of the babies with No other overt neurological sign but tremulousness is generally good, especially when their is no history of complications during pregnancy, or immediately before and after birth.

Newborn tremors

Tremors in newborn are usually not abnormal.

Tremulousness in normal full term newborn babies is their response to stimuli of their new environment.
Every other healthy full term infant develops tremulousness during initial weeks of life. Premature babies are even more prone to jitteriness, more so those who are born to preeclamptic mothers.

It is the presentation of excited neuromuscular activity in newborns.

Jitteriness in newborns is commonly seen as rhythmic tremors of high frequency, and low but equal amplitude.
It involves jaw and limbs.
Jittering is easily initiated in newborns by external stimuli such as handling the baby or loud noise.
It can be easily stopped
1.) Gentle flexing (bending) of the affected limb.
2.) Just holding the limb firmly and reassuringly.
3.) Initiating baby's sucking action also stops the jittery movements.
The tremulous movements are most frequently seen during first few days of life in normal mature babies.
It may extend through out the neonatal period.
It usually resolves spontaneously by 2 months of age. But some infants, with no neurological compromise, may continue to be tremulous till 7 to 9 months of age.
Even harmless jitteriness of infancy can sometime go into clonus.

What is clonus?

Clonus is an involuntary muscular contraction alternated by relaxation in rapid succession.

Commonly seen as coarse tremulous movements of wrist, ankle or jaw.

They are common and less significant in newborn infants than at any other age.

Clonus that is accepted within normal limits for newborns tend to occur only when an infant is active.

Is medical consultation indicated for tremulousness?

Persistent and/or exaggerated jitteriness demands professional evaluation. Sometimes it could be the manifestation of a variety of neonatal problems:

Hypoglycemia; low blood sugar levels.
Hypocalcemia; low calcium levels.
Hypomagnesaemia; low magnesium level in the blood.
Sepsis; severe infection in baby.
Drug withdrawal due to drug used by the mother.
Selective serotonin reuptake inhibitors (SSRIs) prescribed for depression during pregnancy can lead to heightened startle response, tremulousness, irritability, sleep disturbances, nasal congestion and rapid breathing in the newborn baby.
Perinatal asphyxia; childbirth process related compromised oxygen levels in the newborn.
Birth process related bleeding within the skull.
Associated congenital heart defects.
Infants breast fed or born to mothers who use recreational drugs.

Newborn jitteriness can often be mistaken for seizures in newborns or vice versa. Read a relevant post: Strange behavior of 10 Weeks Old infant, & the related comments.

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Neonatal Seizures Vs Jitteriness

Seizures are recurrent sudden abnormal involuntary movements, commonly known as fits or convulsions. There are some distinct differences between neonatal seizures and jitteriness, which are tabulated below.

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Neonatal seizures

Seizures are also known as fits or convulsions.
Seizures during early infancy are often subtle and so easy to miss.

Tongue smacking
Blinking of eyes
Chewing like movements

Seizures in First Three Months of Life Are Often Subtle

Excessive sucking movement without any thing in the mouth to suck on.

a.) Often mistaken for baby's way of saying that she is hungry.

b.) It is also called extra-nutritional sucking; thumb / pacifier sucking.

c.) Extra-nutritional sucking in infants and children is a sign of frustration and stress, or may even be a convulsion.
Generalized convulsions

a.) Tonic and clonic spasms.

b.) Should be differentiated from innocent spasm - see below.
Clonic seizures (convulsions / fits)

a.) Can be focal or multifocal.

b.) Multifocal clonic seizures incorporate several body parts and are migratory in nature.

Common causes of seizures in neonatal period

Injury:

a.) Hypoxic-ischemic encephalopathy

Childbirth process affects newborn health: Compromised oxygen levels and diminished blood flow in the newborn, leading to brain injury.

b.) Intraventricular hemorrhage: A kind of bleeding in the brain

Common Causes of Seizures in Neonatal Period

Drugs in mother can have effect on her baby at the time of birth:

a.) Drug withdrawal from baby due to maternal drug use of narcotic or barbiturates.

b.) Drug toxicity; lidocaine or penicillin administered to the mother during child birth.

Acute metabolic disorders in newborn:

a.) Hypocalcemia; lo blood levels of calcium in the body.

b.) Low blood sugar in baby secondary to diabetes in the mother.

c.) Hypomagnesemia; low blood levels of magnesium in the body.

d.) Hyponatremia; low blood level of sodium in the body.

e.) Hypernatremia; high blood levels of sodium in the body.

f.) Hyperthyroidismg.) Hypoparathyroidism
Inborn errors of metabolism, like Galactosemia

Pyridoxine deficiency

Infections; Neonatal meningitis

What are spasms?

Spasms are sudden generalized jerks lasting 1-2 sec.
They resemble generalized tonic seizures.
Spasms last only for a very short period; less than 2 seconds.
Short span of spasms distinguish them from the generalized convulsions.

Twitching in newborns

Causes of twitching

Newborns sleep
Almost 60 percent of newborns sleep is REM sleep; the light sleep.
REM sleep is prone to dreams; and babies dream just as we adults do.
This can sometimes cause twitching of different groups of muscles; often mistaken for migratory type of convulsion.
Also happens to adults: Noted or felt as twitching during sleep or even sudden gross jerky movements (as missed a step or being pushed).
Part of moros reflex during sleep may be seen as twitching.

Recommended causes for medical consultation for twitching

Each episode of twitching lasts for more than 20 seconds.
Baby’s colour changes from tender pink to pale or bluish during the episodes of twitching, best appreciated on the lips, fingers and toes.
Twitching that persists for more than 3 months of age.

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