Muscle Jerks in Children: Is It Related to Viral Infections?

The patient has symptoms of a cold with muscle twitching, but there are no signs of enterovirus-related mouth sores or other symptoms?

Dear Dr.
Hsiao,
I would like to consult you regarding the issues of enterovirus and cold symptoms.
My child is currently 2 years and 1 month old, a boy weighing approximately 9.5 kg (he is a preterm infant, so he is on the thinner side).

His cold history is as follows:
- On August 23rd, he started having a fever of 38.5 degrees Celsius in the afternoon, without any runny nose or other cold symptoms.
That night, I measured his temperature with an ear thermometer while he was sleeping, and the average temperature was between 39 to 40 degrees Celsius (he did not take any medication at this time, as I wanted to rely on his immune system to recover).
- On August 24th, his temperature averaged around 39.5 degrees Celsius throughout the day.
He began to feel weak, somewhat lethargic, and had decreased activity levels.
His appetite was poor, and during his afternoon nap, I noticed he had startle reflexes, startling approximately every 1 to 2 minutes when he just fell asleep (which would wake him up).
This symptom persisted until he fell into deep sleep, and he would also shake slightly upon waking up (similar to a tremor in his arms and legs).
After observing these behaviors, we took him to the emergency room that night for blood tests.
The doctor reviewed the results and noted no oral lesions, only a slight elevation in white blood cell count, and advised us to monitor him further, as it could not be definitively diagnosed as enterovirus.
That night, he took cold medicine once.
- On August 25th, his temperature averaged between 38 to 39.5 degrees Celsius (slightly lower than the previous two days).
He still exhibited mild startle reflexes during his afternoon nap (but much less intense than the first day).
However, his appetite improved, and his activity level returned to normal.
We followed up with the pediatric clinic, and the doctor advised continued observation.
Since his temperature was not high, he did not receive any medication that day.
He still exhibited startle behavior before falling asleep at 10 PM, but again, it was much less intense than during his earlier nap.
I have a few questions for you, Dr.
Hsiao:
1.
Does enterovirus always cause oral lesions before leading to myoclonic jerks?
2.
Is it possible for my child to have startle-like movements of the limbs when falling asleep or while awake (I only noticed this once while he was awake) that are not related to enterovirus and could resolve on their own as he recovers from the cold?
3.
What other signs should I be vigilant about that may indicate a severe condition?
Thank you for your time and assistance, Dr.
Hsiao.
Sincerely,
Lin's Mother

Lin Mama, 30~39 year old female. Ask Date: 2017/08/26

Dr. Xiao Kaiwen reply Pediatrics

1.
Not necessarily.
2.
In cases of severe enterovirus infection, muscle twitching is typically observed during sleep (this reflex is suppressed when awake).
Normal children may also experience occasional muscle twitching while asleep, but in severe cases of enterovirus infection affecting the central nervous system, muscle twitching is significantly more frequent.
3.
In addition to frequent muscle twitching, severe enterovirus infection can also present with difficulty waking from sleep, poor mental state, severe vomiting, and tachycardia and respiratory distress even in the absence of fever.

Reply Date: 2017/08/26

More Info

Dear Lin Mama,
Thank you for reaching out with your concerns regarding your child's health. I understand that you are worried about the muscle jerks and the potential connection to viral infections, particularly enterovirus. Let's address your questions one by one.

1. Do muscle jerks occur only with enterovirus infections?
Muscle jerks or myoclonic jerks can occur for various reasons and are not exclusively linked to enterovirus infections. While enteroviruses, including those that cause hand, foot, and mouth disease, can lead to symptoms such as mouth sores, fever, and fatigue, not all cases will present with these specific symptoms. Muscle jerks can also be a response to fever, fatigue, or even anxiety in children. In your child's case, the fever and subsequent muscle jerks could be a reaction to the viral infection, but they are not definitive indicators of enterovirus.

2. Could the muscle jerks be unrelated to enterovirus and resolve on their own?
Yes, it is entirely possible that the muscle jerks your child is experiencing are not directly related to enterovirus. Children can exhibit muscle jerks during feverish illnesses due to the body's response to infection. These jerks may occur as the child transitions between sleep stages or due to muscle fatigue. If your child’s overall condition is improving—such as increased appetite and activity levels—there is a good chance that these jerks will resolve as the viral infection runs its course. It is important to monitor the frequency and intensity of these jerks, but they often diminish as the child recovers.

3. What signs should I watch for that might indicate a more serious condition?
While it is common for children to experience mild muscle jerks during illness, there are certain signs that warrant immediate medical attention. You should seek help if:
- The muscle jerks become more frequent or severe.

- Your child exhibits signs of distress, such as persistent crying or inability to be consoled.

- There are changes in consciousness, such as excessive sleepiness or difficulty waking.

- Your child experiences difficulty breathing or shows signs of dehydration (e.g., dry mouth, decreased urination).

- The fever persists for more than a few days or is accompanied by a rash, severe headache, or neck stiffness.

In conclusion, while muscle jerks can be concerning, they are often benign and related to the body's response to illness. It is essential to keep monitoring your child's symptoms and maintain communication with your pediatrician. If you notice any concerning changes or if the symptoms persist, do not hesitate to seek further medical evaluation.

Wishing your child a swift recovery and good health!
Best regards,
Doctor Q&A Teams

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