Tremor in children

Overview

A tremor is an involuntary, rhythmic shaking movement in one or more parts of the body. In children, tremors most often affect the hands, but can also involve the arms, head, voice, or legs. Usually, childhood tremors are harmless and go away on their own, but sometimes they can be a sign of an underlying health issue.

Tremors are fairly common in children, especially in the form of 'physiological tremor' – a normal, tiny shaking that everyone has. However, noticeable tremors that concern parents happen less often.

Tremors can affect children of any age, from toddlers to teenagers. Some types are more common in certain age groups – for example, essential tremor often starts in adolescence.

Symptoms

Common symptoms

• Rhythmic shaking in one or both hands or arms
• Shaking when holding something or performing a task (action tremor)
• Shaking that disappears when the child is asleep
• Head nodding or trembling voice in some cases

Symptoms in children

• Tremor may be more noticeable when the child is tired, anxious, or excited.
• Children may have trouble with fine motor tasks like drawing, writing, or using utensils.
• The tremor can come and go, and may get worse with stress or caffeine.
• Often there are no other symptoms, and the child is otherwise healthy.

Symptoms in older adults

• This section is not directly relevant for children, but in adults with tremor, causes and treatments are often different.

Causes

Main causes

• Physiological tremor – a normal, tiny shaking everyone has, sometimes exaggerated by stress, fatigue, or caffeine.
• Essential tremor – a genetic condition that causes a slow, rhythmic shaking, often in the hands and head.
• Anxiety or panic attacks that can trigger temporary shaking.
• Overactive thyroid (hyperthyroidism) – a gland that produces too much thyroid hormone.
• Certain medications or stimulants like asthma inhalers or decongestants.
• Neurological conditions such as a brain injury or a disorder of the cerebellum (the part of the brain that controls movement).

Risk factors

• Family history of essential tremor or other movement disorders.
• Excessive caffeine from energy drinks, soda, or coffee.
• High levels of stress or anxiety.
• Certain medical conditions like thyroid problems or low blood sugar.

When to see a doctor

See a doctor urgently if:

• Tremor that appears suddenly after a head injury or illness
• Tremor with fever, stiff neck, or vomiting
• Tremor with weakness, confusion, or difficulty speaking

Book a routine appointment if:

• Tremor that lasts for more than a few weeks or gets slowly worse
• Tremor that interferes with school work, eating, or other daily activities
• Any tremor that concerns you or your child
• Tremor that only affects one side of the body

Diagnosis

A doctor will start by taking a full history and doing a physical exam. They will watch your child perform tasks like holding a glass or writing to see the tremor. They may ask about family history, medications, and possible triggers. Sometimes, simple tests are done to check for underlying causes.

Tests that may be done

• Blood tests to check thyroid function, blood sugar, and other metabolic causes
• Imaging tests like an MRI of the brain if a neurological cause is suspected
• Tremor analysis – a test that measures the frequency and pattern of the shaking

What to expect at your appointment

The doctor will explain what type of tremor your child likely has and whether it needs treatment. They will also discuss any necessary lifestyle changes or follow-up. Most children with benign tremors will not need ongoing care.

Treatment

Treatment depends on the cause and how much the tremor affects your child's life. For most children, simple lifestyle changes are enough. If an underlying condition is found, treating that condition often stops the tremor. Medications are rarely used in children because side effects can be significant.

Self-care at home

• Reduce or eliminate caffeine from drinks and foods.
• Make sure your child gets enough sleep every night.
• Help your child manage stress with relaxation techniques or talking about worries.
• Avoid overstimulation and ensure regular meals to keep blood sugar stable.

Medical treatments

If the tremor is due to a medical problem like an overactive thyroid, treating that problem usually reduces the tremor. For severe essential tremor that interferes with daily life, a doctor may consider medication, but this is uncommon in children. Never give any medication without a doctor's prescription.

When is surgery considered?

Surgery, such as deep brain stimulation, is very rarely considered for children and only for disabling tremors that do not respond to other treatments. This would be discussed with a specialist team.

Living with this condition

For most children, tremor is just a minor inconvenience. Encouraging your child to focus on the task at hand, using a calm environment, and allowing extra time for activities can reduce frustration. Many children outgrow their tremor or learn to manage it well.

Lifestyle tips

• Use weighted utensils or pens if fine motor tasks are hard.
• Encourage a balanced routine with regular sleep and meals.
• Promote relaxation techniques like deep breathing or yoga.
• Talk openly with your child about the tremor and reassure them it is not dangerous.

Diet and exercise

A healthy diet with limited caffeine and sugar can help. Regular physical activity can reduce stress and improve coordination. There is no special diet proven to cure tremor, but staying active and eating well supports overall health.

Mental health and emotional wellbeing

Some children may feel self-conscious about their tremor, especially if it is visible to others. This can lead to anxiety or avoidance of social situations. It is important to listen to your child's feelings and offer reassurance. If worry persists, consider speaking with a school counsellor or child psychologist.

Prevention

Many causes of tremor cannot be prevented, especially genetic ones. However, avoiding triggers like caffeine, ensuring good sleep, and managing stress may reduce the chance of physiological tremor becoming noticeable.

Vaccines

This does not apply directly to tremor prevention, but routine childhood vaccines are important for overall health.

Screening programmes

There is no routine screening for tremor. If there is a family history of essential tremor, you may choose to watch for signs, but no screening is needed for most children.

Complications

If left untreated

• If the tremor is caused by an underlying condition (like thyroid disease) that is not treated, that condition could worsen.
• Rarely, a severe neurological cause could progress, leading to other problems like stiffness or balance issues.
• Social or emotional difficulties if the child feels embarrassed or avoids activities.

Long-term outlook

The outlook for children with tremor is very good. Most benign tremors improve or disappear on their own. Even essential tremor often remains mild throughout life. With support and simple adjustments, children can lead full, active lives without significant limitations.

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