Twitching and Jitteriness in Preemies

Mother kissing baby
KristinaGreke / Getty Images

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

Overview

Jerky or shaky gestures are usually completely normal and harmless. However, seizures are can appear similar and do warrant concern. How can you tell when to worry and when a movement is normal?

Here are some causes of twitching and jitters, how to tell the difference between a natural movement and a seizure, and when you should be concerned.

Twitching 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 twitching during sleep is related to a child’s sensory-motor development.

At different developmental stages, different body parts twitch. For example, during the neonatal period, the 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, the twitching of the wrists and fingers may help in the development of fine motor skills.

Jitteriness looks like fine tremors, trembling, or shakiness. You might 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 your baby suck. Try giving your child a pacifier or a feeding to stop the trembling.

Natural Causes

Some causes of jerking or twitching are relatively normal for preemies and older babies.

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

While it can be jarring for parents to see, it's normal for babies (whether they are premature or full-term) 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, tea, or soda) the caffeine you consume will go into your breast milk. A small amount of caffeine usually isn't a problem. However, larger amounts can be passed to your baby during breastfeeding and get into their system.

Too much caffeine might cause your baby to become irritable, have difficulty sleeping, and begin to show signs of twitching or the jitters.

Medical Causes

There are some medical causes of trembling or shaking. These can be serious and warrant a call to your pediatrician.

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 the person who carried them had diabetes or preeclampsia during pregnancy.

In this case, feeding might be all it takes to increase a baby's blood sugar levels 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, they may need intravenous (IV) fluids to correct the issue.

Drug Withdrawal

Infants born to people with substance use disorders can have tremors, twitching, and shaking in the days or weeks following birth. Some babies do not need any treatment for drug 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. 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.

A seizure might also 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.

Seizures can look like normal, harmless movements. It might take more than just an observation to make the distinction between the two. A doctor might order certain tests such as an EEG (electroencephalogram), an MRI (magnetic resonance imaging), or a CAT Scan (computed tomography scan) if they think your baby might have had a seizure.

When to Be Concerned

Preemie seizures tend to be mild. It can be difficult to tell the difference between a seizure and normal twitching. There are some signs that you can watch for that warrant immediate medical attention.

  • The tremors go on for more than 10 to 20 seconds (seizures typically last longer than normal twitching).
  • Your baby has an episode of apnea (stops breathing) while they are 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 they might during a seizure.
  • 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.
  • Your child has abnormal eye movement along with body movements. Quick eye movements during REM sleep are normal, but if your baby is stiffening up or jerking and you notice your baby's eyes rolling or moving to the sides, they could be having a seizure.

A Word From Verywell

The first time you notice your baby twitching in their sleep or see their leg shaking while they are crying, it can be shocking. If you are worried your baby is having a seizure, try to remember that these movements are very common among preemies and even full-term babies.

Most of the time, jitteriness or trembling is not dangerous. That said, if you are ever concerned about your child’s behaviors, talk to the doctor. You can even take a video of the movement when it happens to bring to your pediatrician. Chances are, they will be able to reassure you that the movements are normal. If the are not, you will be able to take the next steps needed to make sure your baby gets the medical care they need.

Twitching and jitteriness are normal in preemies and full-term infants, but seizures do warrant concern. Seizures are sometimes caused by a serious medical condition such as an infection, a lack of oxygen to the brain, or a neurological problem.

While many preemies who have neonatal seizures will grow and develop normally, seizures still have to be treated and followed carefully. Make sure that you know the signs and if you notice them, seek immediate medical care.

Was this page helpful?
Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Rosman NP, Donnelly JH, Braun MA. The jittery newborn and infant: a review. J Dev Behav Pediatr. 1984;5(5):263-73.

  2. Adolph KE, Franchak JM. The development of motor behaviorWiley Interdiscip Rev Cogn Sci. 2017;8(1-2):e1430. doi:10.1002/wcs.1430

  3. Institute of Medicine (US) Roundtable on Environmental Health Sciences, Research, and Medicine. Preterm Birth and Its Consequences. In: Mattison DR, Wilson S, Coussens C, et al., editors. The Role of Environmental Hazards in Premature Birth: Workshop Summary. Washington, DC: National Academies Press (US); 2003.

  4. Wulbrand H, McNamara F, Thach BT. The role of arousal related brainstem reflexes in causing recovery from upper airway occlusion in infants. Sleep. 2008;31(6):833-840. doi:10.1093/sleep/31.6.833

  5. Futagi Y, Toribe Y, Suzuki Y. The grasp reflex and moro reflex in infants: hierarchy of primitive reflex responsesInt J Pediatr. 2012;2012:191562. doi:10.1155/2012/191562

  6. Institute of Medicine (US) Committee on Sleep Medicine and Research. Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. In: Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press (US); 2006.

  7. Panayiotopoulos CP. Neonatal Seizures and Neonatal Syndromes. In: The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing; 2005.

  8. Guidelines for diagnosis and management of childhood epilepsy. Indian Pediatr. 2009;46(8):681-98.

  9. Chadha IA. Neonatal resuscitation: Current issuesIndian J Anaesth. 2010;54(5):428-438. doi:10.4103/0019-5049.71042

  10. Reuter S, Moser C, Baack M. Respiratory distress in the newbornPediatr Rev. 2014;35(10):417-429. doi:10.1542/pir.35-10-417

Additional Reading
  • 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.

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

  • 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.
  • 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.