Twitching and Jitteriness in Preemies: When to Be Concerned

The Difference Between Normal Movements and Seizures

Mother kissing baby
KristinaGreke / Getty Images

Preemies twitch. They also shake, tremble, and get the jitters. Even full-term newborns are twitchy and jittery. But, where full-term infants outgrow the twitchiness in a few weeks or months, premature babies tend to be twitchy and jumpy and display their newborn reflexes for a few months longer as their little bodies grow and try to catch up.

Most of the time, these jerky or shaky gestures are completely normal and harmless.

However, seizures can often look a lot a like these normal movements, and they're something to be concerned about. So, when is it OK and when should you worry? Here are some of the leading causes of twitching and jitters, how to tell the difference between these natural movements and seizures, and when to be concerned.

Twitching and Jitteriness in Preemies

Twitching is a jerking movement that usually only lasts a few seconds, but it can happen repeatedly. You may see it when your child is startled or sleeping. Babies also twitch in response to being held, moved, or hearing a loud noise. Sometimes, these jerking movements occur for no reason at all. Some researchers believe that the twitching during sleep is related to the child’s sensory motor development.

And, that at different developmental stages, different body parts twitch. For example, during the neonatal period, twitching of the head and extremities help prepare the baby for holding up his head and learning what his arms and legs can do.

Then, as the child grows, twitching of the wrists and fingers may help the development of fine motor skills.

Jitteriness looks like fine tremors, trembling, or shakiness. You may notice your baby’s arms, legs, or jaw shaking uncontrollably. Jitters usually stop on their own or when you grasp and hold the body part that’s trembling.

You can also calm the jitters by letting the baby suck. So, giving your child a pacifier or a feeding can stop the trembling.

Natural Causes

Immature Nervous System: Newborn and preemies have an immature nervous system. The pathways that carry the signals from the brain to the parts of the body aren’t yet fully developed, so movements can appear jerky and twitchy. The jerking and twitching will get better as the baby’s nervous system matures. It just takes a little longer for preemies.

Normal Movements During Sleep: Preemies move when they’re awake, and they move in their sleep, too. They may jolt or have rhythmic or jerking body movements. During the REM (rapid eye movement) stage of sleep, you may notice quick eye movements along with twitches or other body motions.

Crying: It’s normal for babies to shake, tremble, or stiffen up when they cry.

The Startle (Moro) Reflex: A baby will jump or twitch when he's suddenly surprised. It looks like the child’s whole body stiffens up then the arms and legs quickly straighten out and the hands open. The baby then pulls his arms and legs back in close to his body. The startle reflex only lasts a few seconds. You will most likely see the startle reflex if the baby is moved unexpectedly or hears a loud noise.

Too Much Caffeine in Breast Milk: If you’re breastfeeding and you drink a lot of caffeinated beverages such as coffee or soda, the caffeine does go into your breast milk. A little bit of caffeine isn’t usually a problem. But, in large amounts, it can pass to your baby and build up in his body. Too much caffeine can cause a child to become irritable, have difficulty sleeping, and begin to show signs of twitching or the jitters.

Medical Causes

Low Blood Sugar: One of the first signs of low blood sugar (hypoglycemia) is shaking. If a baby’s blood sugar (glucose) levels drop, it can cause shaking and tremors.

Low blood sugar is a common issue that preemies face, especially if mom had diabetes or preeclampsia during pregnancy. A feeding may be all it takes to increase the blood sugar and stop the tremors.

Other Electrolyte Imbalances: Low sodium (hyponatremia), low calcium (hypocalcemia), and low magnesium (hypomagnesemia) can cause an increase in muscle activity which looks like jerking or twitching. If your child has an electrolyte imbalance, she may need intravenous (IV) fluids to correct the issue.

Drug Withdrawal: Infants born to mothers who have struggled with substance abuse can have tremors, twitching, and shaking for days or weeks after birth. Some babies do not need any treatment for withdrawal, but it depends on the drug and the severity of the symptoms.

Seizures

When you imagine a seizure, you probably think of uncontrollable shaking and thrashing. But, in preemies, a seizure doesn’t necessarily look that way. It might be a repeated jerking movement of the arms or legs, but it can also look like a repetitive motion of mouth and tongue or the head. It may look like your baby is blinking or staring at something, or it can be the continuous arching or stiffening up and relaxing of the body or a part of the body.

Many times, seizures can look like normal, harmless, movements, so it may take more than just an observation to make the distinction between the two. A doctor may order certain tests such as an EEG (electroencephalogram), an MRI (Magnetic Resonance Imaging), or a CAT Scan (Computed Tomography Scan) if a seizure is suspected.

When to Be Concerned

Since preemie seizures tend to be mild, it can be difficult to tell the difference between a seizure and normal twitching. If you’re home with your baby, you should be concerned if:

  • You can’t stop the twitching by placing your hand over the body part that’s moving. Jitteriness or normal tremors can be stopped by holding the body part that's trembling. Seizure activity will continue even if the body part is being held.
  • The tremors continue for more than 10 to 20 seconds. Seizures typically last longer than normal twitching.
  • The baby has an episode of apnea (stops breathing) while she’s making continuous movements or you notice your child’s skin color change to pale or blue. A child will not stop breathing during normal twitchy or jittery movements, but may during a seizure.
  • Your child has abnormal eye movement along with body movements. Quick eye movements during REM sleep are normal, but it could be a seizure if your baby is stiffening up or jerking and you notice your baby's eyes rolling or moving to the sides.

A Word From Verywell

The first time you notice your baby twitching in her sleep or see her leg shaking while she’s crying, it can be shocking. The thought of seizures and a life-long neurological problem is scary. But, try to remember that these movements are very common among preemies and even full-term babies. Most of the time, they’re not dangerous at all. Of course, if you ever have a concern or question about your child’s behaviors, talk to the doctor. You can even take a video of what you see if you can catch it. The doctor can put your fears to rest about the normal movements that babies make.

However, even though twitching and jitteriness are normal in preemies, seizures are a concern. Seizures can be the result of a more serious condition such as an infection, a lack of oxygen to the brain, or a neurological problem. And, while many preemies who have neonatal seizures go on to grow and develop normally, seizures still have to be treated and followed carefully. So, if you see any of the concerning signs listed above, try to stay calm and seek immediate medical attention.

Sources:

Blumberg MS, Coleman CM, Gerth A, McMurray B. Spatiotemporal structure of REM sleep twitching reveals developmental origins of motor synergies. Current Biology. 2013 Nov 4;23(21):2100-9.

Levene M. Neonatal Seizures. Neonatology. Springer Milan. 2012. 1199-1207.

Malone A, Anthony Ryan C, Fitzgerald A, Burgoyne L, Connolly S, Boylan GB. Interobserver agreement in neonatal seizure identification. Epilepsia. 2009 Sep 1;50(9):2097-101.

Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2008 May 1;93(3): F187-91.

Orivoli S, Facini C, Pisani F. Paroxysmal nonepileptic motor phenomena in newborn. Brain and Development. 2015 Oct 31;37(9):833-9.

Continue Reading