Neonatal Seizure Signs Every Parent Should Know
The short answer
Neonatal seizures can look very different from seizures in older children and adults, which makes them easy to miss. Rather than dramatic full-body convulsions, newborn seizures often present as subtle, repetitive movements: rhythmic lip smacking, tongue thrusting, cycling movements of the legs, eye deviation, apnea (pauses in breathing), or brief episodes of stiffening. Neonatal seizures affect approximately 1-5 per 1,000 live births and can indicate serious underlying conditions including birth injury, infection, metabolic disorders, or brain malformation. Any suspected seizure in a newborn requires urgent medical evaluation.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
0-7 days
The first week of life is when neonatal seizures most commonly occur. Causes in this early period include hypoxic-ischemic encephalopathy (birth-related brain injury), intracranial hemorrhage, metabolic disturbances (low blood sugar, low calcium, low sodium), infections (meningitis, encephalitis), and drug withdrawal. Seizures may look like: repetitive mouth movements (lip smacking, chewing), eye deviation or fluttering, rhythmic limb movements that cannot be stopped by gently holding the limb, apnea with changes in heart rate, or brief episodes of tonic stiffening. Normal newborn movements like jitteriness stop when you gently hold the limb; seizures do not.
1-4 weeks
Seizures presenting after the first week may indicate different causes, including late-onset infections, inborn errors of metabolism, benign neonatal seizures (a diagnosis of exclusion), or structural brain abnormalities. If you notice any repetitive, stereotyped movements that seem involuntary, try to video record the episode to show your doctor, as seizures may not occur during medical examination. An EEG (electroencephalogram) is the gold standard for confirming seizures. Treatment depends on the underlying cause, with anti-seizure medications used when seizures are confirmed.
1-3 months
Infantile spasms, a specific seizure type, can begin as early as 2-3 months (more commonly 4-8 months). These appear as brief clusters of sudden flexion or extension movements, often occurring upon waking. Each spasm lasts only 1-2 seconds, but they occur in clusters that can last several minutes. Infantile spasms require urgent treatment (usually within days of diagnosis) because delayed treatment is associated with worse developmental outcomes. If you see brief, repetitive flexion or "jackknife" movements in your baby, seek evaluation immediately.
What Should You Do?
When to take action
- Your newborn has jitteriness or trembling that stops when you gently hold the affected limb, which is common and typically benign.
- Your baby has brief startle reflexes (Moro reflex) that cause their arms and legs to jerk outward.
- Your baby has occasional hiccups, sneezes, or brief muscle twitches during sleep, which are normal.
- You observed a brief episode that looked unusual but your baby seems fine now - describe it in detail to your pediatrician and share any video you captured.
- Your baby has jitteriness that seems excessive or that does not stop when you hold the limb.
- Your baby has episodes of staring or unresponsiveness that you are unsure about.
- Your baby has rhythmic jerking movements of the face, arms, or legs that cannot be stopped by gently holding the limb.
- Your baby has an episode of eye deviation, lip smacking, or cycling leg movements accompanied by color change, apnea, or unresponsiveness.
- Your baby has clusters of brief flexion or extension movements (possible infantile spasms) - seek urgent evaluation the same day.
- Your baby has any seizure-like activity and also has fever, lethargy, poor feeding, or a bulging fontanelle.
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Medical Concerns
My Baby Had a Febrile Seizure
Febrile seizures are frightening to witness but are usually harmless. They affect about 1 in 25 children, typically between 6 months and 5 years, and almost never cause lasting harm. Most children who have one febrile seizure never have another, and they don't increase the risk of epilepsy significantly.
Neonatal Fever and Sepsis Workup - What Parents Need to Know
A fever of 100.4 degrees F (38 degrees C) or higher in a baby under 60 days old is a medical emergency that requires immediate evaluation, even if the baby appears well. This is because young infants' immature immune systems cannot effectively localize infections, and serious bacterial infections (including meningitis and sepsis) can present with fever as the only symptom. A standard sepsis workup includes blood tests, urine culture, and often a lumbar puncture (spinal tap). While this is frightening for parents, it is a well-established, evidence-based protocol that saves lives.
Newborn Jaundice and Kernicterus Prevention
Newborn jaundice, a yellowing of the skin and eyes caused by elevated bilirubin levels, affects approximately 60% of full-term and 80% of preterm newborns. Most cases are physiologic (normal) and resolve on their own within 1-2 weeks with adequate feeding. However, severely elevated bilirubin that is not treated can cause kernicterus, a form of permanent brain damage. Kernicterus is preventable with proper monitoring and timely phototherapy or, rarely, exchange transfusion. All newborns should be screened for jaundice before hospital discharge, and parents should watch for warning signs in the first 2 weeks of life.
My Baby's Head Shape Looks Abnormal
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Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.