Baby Tremors: Causes, Concerns, and When to Seek Help

Baby's hand tremors issue?

Hello, Doctor.

1.
My baby is currently 6 months and 21 days old.
On December 20th of last year, he accidentally fell from an 80 cm changing table, resulting in intracranial hemorrhage.
A CT and MRI performed by the doctor showed a hematoma in the sensory area, and at that time, due to elevated intracranial pressure, there was bulging of the anterior fontanelle accompanied by vomiting.
He was hospitalized for treatment and has since recovered.
Upon discharge, there were no neurological symptoms.
During a follow-up appointment on February 1st, the doctor mentioned that the hematoma had mostly resolved.
However, on the evening of the same day after receiving his 6-month vaccinations, I noticed my baby seemed to have slight hand tremors while playing in his stroller.
This lasted only 3-5 seconds and then stopped quickly.
I would like to know if this is normal, or could it possibly be a residual effect of the intracranial hemorrhage, or a symptom that may occur after vaccination?
2.
During my baby's hospitalization, an EEG was performed, and the doctor stated that aside from slow waves at the injury site, there were no epileptiform discharges.
I would like to ask if having no issues on the EEG means that the likelihood of developing epilepsy is very low, or that he may not exhibit any seizure symptoms at all?
3.
I am concerned about the possibility of missing signs of seizures and delaying medical attention.
How can I differentiate between normal limb movements in infants and abnormal movements?

Xiao Pingguo, 30~39 year old female. Ask Date: 2021/02/02

Dr. Zhang Junwei reply Neurosurgery

It's hard to determine whether the tremors you see are due to epilepsy.
It is recommended to record a video on your phone during the episode and then consult a physician in an outpatient setting for evaluation and management.

Reply Date: 2021/02/02

More Info

When it comes to understanding baby tremors, especially in the context of a history of head trauma, it is crucial to approach the situation with care and informed awareness. Your concerns regarding your 6-month-old baby, who experienced a fall resulting in intracranial bleeding, are valid and warrant a thorough understanding of the potential implications.

1. Tremors Post-Injury: The mild hand tremors you observed could be a normal part of infant development, especially since they are common in babies as they learn to control their movements. However, given your baby's medical history, it is essential to differentiate between typical developmental tremors and those that may indicate a neurological issue. The fact that these tremors lasted only a few seconds and ceased quickly is reassuring. In infants, tremors can often be benign and related to excitement or fatigue. However, if these tremors become more frequent, prolonged, or are accompanied by other concerning symptoms (such as changes in consciousness, unusual movements, or developmental delays), it would be prudent to consult your pediatrician or a pediatric neurologist.

2. Post-EEG Findings: The EEG results indicating no epileptiform activity are encouraging. While the presence of slow waves at the site of injury is not uncommon, the absence of seizure activity suggests a lower likelihood of developing epilepsy. However, it is important to note that the risk of seizures can vary based on the nature and severity of the initial injury. Continuous monitoring of your child's development and behavior is essential. If you notice any signs of seizures—such as unusual eye movements, stiffening of the body, or unresponsiveness—seek immediate medical attention.

3. Distinguishing Normal from Abnormal Movements: Understanding the difference between normal and abnormal movements in infants can be challenging. Normal movements in infants include reflexive actions, random jerks, and occasional tremors, especially when they are excited or tired. Abnormal movements may include:
- Repetitive movements that are not typical for the age (e.g., rhythmic shaking of the hands or limbs).

- Stiffness or rigidity in the limbs that does not seem to be related to normal reflexes.

- Unresponsiveness during episodes of unusual movement.

- Changes in behavior, such as increased irritability or lethargy.

If you are ever in doubt about your baby's movements or behavior, it is always best to err on the side of caution and consult with a healthcare professional. They can provide guidance tailored to your baby's specific medical history and current condition.

In summary, while the tremors you observed may be benign, continuous observation and communication with your healthcare provider are key. Regular follow-ups and developmental assessments will help ensure that your baby is progressing well and that any potential issues are addressed promptly. Remember, as a parent, your intuition and observations are invaluable in monitoring your child's health and development.

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