Shuddering attacks in babies: not a seizure

• An episode lasts 1–5 seconds and can repeat anywhere from a few times to dozens of times a day
• Fast, small-amplitude shaking of the head, shoulders and arms, sometimes the whole body, like a person shivering
• It mostly happens during excitement, joy, anticipation or feeding
• Awareness is not lost: the child stays connected with their surroundings, the eyes do not roll, and the color does not change
• It stops when you distract the child, and there is no limpness or sleepiness afterward
• It usually begins between 4 and 14 months; in some reports, the onset coincided with teething
• It goes away completely by age 3–7; in studies, the latest recorded was age 10

The neurological exam is normal, development is appropriate for age, and the EEG shows no epileptic changes. In a series of 12 children, 58% were first referred with suspected “epilepsy,” but none had epileptiform activity on EEG, and in all of them the episodes resolved by age 3–7. Video-EEG studies also confirm that these episodes are not epileptic. Family studies have not confirmed a link between shuddering attacks and essential tremor.

In rare cases, some forms of epilepsy (for example, frontal lobe seizures) can look like a shuddering attack. The difference is that in epilepsy, episodes come on waking from sleep, happen without a trigger, sometimes come with a change in awareness, and do not respond to treatment. If the neurological exam is normal, the episodes are typical and the EEG (when indicated) is normal, no extra testing or medication is needed; the parents are told the condition is benign, and the child is followed.

1. Record the episode on video: when it started, what the child was doing, how long it lasted.
2. Try to distract your child. If the episode stops, that points toward a benign cause.
3. If you notice a change in awareness, rolling eyes, a color change, episodes during sleep or limpness afterward, that is a different picture; see the first aid steps on the seizures and epilepsy page and have your child examined promptly.
4. Come in for an exam. If your child’s exam is normal, you can often get an answer the same day.

This article is for educational purposes and does not replace an exam by a pediatric neurologist.