No, seizures in newborns are never normal; any seizure-like episode needs urgent medical assessment and prompt care.
Seeing odd movements or staring spells in a new baby can rattle any parent. Some twitches are harmless. True convulsive events point to a brain problem that needs quick checks. This guide explains what counts as a seizure in the first month of life, what looks similar but isn’t, when to seek care, and what doctors usually do next.
Are Infant Seizures Normal? What Doctors Say
Doctors use the term neonatal seizures for seizure activity from birth to 28 days. These events are a medical emergency. They often signal low oxygen around birth, stroke, metabolic problems, infection, bleeding, or a structural brain issue. Even short clusters can stress an immature brain, so teams aim to find the cause and stop the events quickly.
Fast Check: Seizure-Like Signs Versus Benign Shaking
Newborns shake easily. Cold, hunger, or a startle can bring on jitteriness. The table below compares common signs parents see at home. Use it to spot red flags that need same-day care.
| Sign | What It Looks Like | What It Suggests |
|---|---|---|
| Rhythmic jerks that don’t stop with gentle touch | Repeated twitches in a limb or face; spreads or comes in bursts | More in line with a seizure |
| Staring with eye deviation | Eyes pull to one side; baby seems “locked in” | Concerning for seizure activity |
| Lip smacking or chewing | Mouth movements with no feeding | May be an automatism linked to a seizure |
| Apnea or color change | Pauses in breathing, blue or gray tone | Emergency; call local emergency number |
| Jitteriness that stops with holding the limb | Fine tremor; ceases when the limb is flexed or soothed | Usually benign tremor |
| Startle after noise or touch | Brief jump, then settles | Normal reflex |
Why Early Care Matters
Newborn brains heal best when teams act fast. Treating the trigger—like low sugar, low calcium, infection, or a bleed—can stop the events and protect brain tissue. Many units now use continuous EEG or amplitude-integrated EEG to catch both obvious and subtle events, since some seizures show little outward movement.
Common Causes, From Most To Less Frequent
Low Oxygen Around Birth
A tough birth can leave areas of the brain short on oxygen. Events often start within the first day. Babies with this history are watched in the nursery or NICU with aEEG/EEG, and some receive cooling therapy under strict protocols.
Stroke In A Newborn
Clots or bleeding can injure part of the brain. A focal arm or face jerk on one side raises concern.
Metabolic Triggers
Low blood sugar, low calcium, low magnesium, or electrolyte shifts can spark events. A quick heel-stick or blood draw guides treatment, which often stops the spells once levels are corrected.
Infection
Sepsis or meningitis can present with temperature problems, poor feeding, and seizure-like behavior. Doctors may start antibiotics or antivirals while tests run.
Structural And Genetic Conditions
Some babies are born with brain malformations or channelopathies that lower the seizure threshold. Teams may order genetic panels when the cause isn’t clear, events are hard to control, or family history points that way.
What To Do During An Episode
Safety comes first while you wait. Stay calm.
- Place the baby on a flat surface on the side, keep the airway clear, and loosen tight clothing.
- Do not put anything in the mouth or try to hold the tongue.
- Time the spell and record a video on your phone if safe to do so.
- Call your local emergency number for any episode longer than a couple of minutes, breathing pauses, color change, or repeated clusters.
How Clinicians Confirm The Diagnosis
Staff review the story, check the baby, and run targeted tests. Core steps often include:
Bedside Monitoring
Continuous EEG or aEEG tracks brain waves and catches “silent” events. This helps tailor medicine and avoid overtreatment when movements aren’t seizures.
Blood And Lumbar Tests
Glucose, electrolytes, calcium, magnesium, blood gas, infection labs, and sometimes spinal fluid checks guide next steps.
Imaging
Cranial ultrasound at the bedside can spot bleeds in preterm infants. MRI gives detail on stroke, hypoxic injury, or malformations and is often done once the baby is stable.
For a clinical overview suited to families, see the NINDS neonatal seizure page. For clinician-level detail, the ILAE treatment recommendations outline when to start medicine, which second drugs may follow, and when tapering is safe.
First-Line Medicines And Care Steps
Teams carefully treat the cause and the electrical events. Many centers start with phenobarbital, given its long track record in the nursery. If events continue, options like levetiracetam, phenytoin, or midazolam may follow, guided by EEG response and the baby’s status. When a metabolic cause is found, fixing that problem is the main therapy. A trial of pyridoxine may be used in select cases with no clear cause.
When Medicines Stop
For acute provoked events that resolve and an EEG that quiets, many units stop anti-seizure medicine before discharge, once the baby has stayed seizure-free for a set period. Plans vary by center and by cause, and families leave with clear follow-up.
Home Clues That Deserve Urgent Care
- Any spell with color change, limpness, or breathing pauses
- Clusters across a day
- Movements that persist when you gently hold the limb
- Eye deviation or fixed stare with no response
- Poor feeding, fever, or hard-to-wake behavior paired with odd movements
Feeding, Sleep, And Daily Care After A NICU Stay
Parents often ask about feeding, sleep, and handling at home. Stick with the feeding plan from your team. Keep regular newborn sleep habits and safe-sleep rules. Track spells in a simple log with times and triggers. Bring the log and videos to follow-ups. If your baby is on medicine, give doses on time and ask before stopping or changing any dose. Bring backup syringes.
Types Of Seizure Patterns In Newborns
Not all events look like the classic shake seen in older kids. Patterns in this age group tend to be brief and subtle. Spotting these helps you capture a helpful video and seek care fast.
Clonic
Slow, rhythmic jerks in a limb, sometimes marching from hand to arm to face. The movement keeps a steady beat and does not stop when you hold the limb. Eyes may pull to one side.
Tonic
A sudden stiff posture with straight arms or a bent posture with the arms flexed. Breathing can pause. This pattern calls for immediate care.
Myoclonic
Lightning-fast twitches that come in clusters. These may be hard to catch on a short clip, so timing and notes help the team.
Autonomic And Subtle
Changes in breathing, color, eye flutter, chewing, or pedaling motions. These signs can be easy to miss, which is why EEG plays such a large part in this age group.
When It Isn’t A Seizure
Three patterns often scare parents but usually turn out benign:
- Benign sleep myoclonus: Quick jerks only during sleep that stop when the baby wakes.
- Gastroesophageal reflux: Arching, spit-ups, and brief choking sounds during or after feeds.
- Normal startle (Moro) reflex: A quick fling of the arms after a loud sound or sudden movement.
Even with these patterns, any color change, breathing pause, or poor feeding calls for a same-day visit.
Long-Term Outlook And Follow-Up
Many babies with a short-lived trigger—like low sugar corrected fast—do not develop epilepsy. Babies with stroke, a brain malformation, or a genetic epilepsy face higher risk and need close neurology care with clear goals for the first year.
Development can range widely. Early therapy, hearing checks, vision checks, and milestone tracking spot gaps sooner. Ask about early-intervention programs in your region. A simple home log and short phone videos help teams adjust plans between visits.
Typical Workup And Timeline In The Hospital
Families often ask about vaccines and routine meds. Newborns follow the standard schedule; shots do not trigger neonatal seizures. Always review supplements with your clinician to avoid drug interactions.
| Step | Usual Timing | What Parents May See |
|---|---|---|
| Stabilize and check sugar/electrolytes | Minutes to 1 hour | Blood draw, IV line, bedside glucose |
| Start EEG or aEEG | First hours | Small leads on scalp; monitor near crib |
| Start medicine if EEG or exam supports seizures | Same day | Loading dose, then maintenance |
| Search for cause | First 24–48 hours | Labs, spinal tests, cranial ultrasound or MRI |
| Adjust care as results return | 48–72 hours | Medicine changes or weans |
| Plan for discharge and follow-up | By day 3–7 | Home dosing plan, red-flag review |
Plain-Language Takeaways For Parents
- Seizures in the first month are a medical emergency, not a normal newborn pattern.
- Jitteriness that stops with touch is common; events that push past that need same-day checks.
- Teams treat cause first, seizure control next, and careful follow-up after.
- Set phone alarms for dosing times. Use a dedicated dosing syringe daily.