Tremors in Children: Causes, Symptoms, and Treatments Parents Can Trust

Your child’s hand shakes while they’re holding a spoon. For a second your stomach drops: is it stress, sugar, or something serious? You want a straight answer and a plan. You’ll get both here - what’s normal, what’s not, the fast checks you can do at home, when to book your GP, and how doctors actually treat pediatric tremor. I’m a dad in Adelaide with two kids (one of mine started shaking after an energy drink once), and I know that mix of curiosity and fear. Let’s turn that worry into steps you can act on today.

• Most childhood shaking is benign - stress, fever, caffeine, fatigue, or common meds (like asthma puffers) often explain it.
• Red flags: tremor plus weakness, trouble walking, severe headache, confusion, injury, or it’s getting rapidly worse - seek urgent care.
• Do-now checklist: hydrate, feed, cut caffeine, review medicines, note the pattern, film a short video, and book your GP if it persists.
• Essential tremor does happen in kids, often with a family history; it’s treatable with therapy, school supports, and sometimes medication.
• Doctors look at tremor type (rest vs action), triggers, and simple tests before ordering labs like thyroid, electrolytes, or copper studies.

What causes tremors in children (and what’s normal vs. not)?

First, a clean definition keeps us honest:

“Tremor is an involuntary, rhythmic, oscillatory movement of a body part.” - International Parkinson and Movement Disorder Society

Translation: a true tremor is a rhythmic shake you can see or feel. Kids can also have twitches, tics, shivers, or seizures - those aren’t tremors. We’ll stick to tremor here and tell you when to think beyond it.

Big picture: most kids’ shaking falls into three buckets.

• Enhanced physiologic tremor: A normal, tiny tremor that gets louder when a child is tired, anxious, hungry, feverish, dehydrated, or has too much caffeine. Beta-agonist asthma inhalers (like salbutamol), some ADHD meds, SSRIs, and thyroid hormone can amplify it. Often shows up as hand shaking when holding a cup or doing fine tasks, and it fades when the trigger is gone.
• Essential tremor (ET): An action/postural tremor (shows when holding posture or during movement) that can run in families. It’s usually symmetrical in the hands, starts gradually, and may get in the way of writing or eating. About half of people with ET have a first-degree relative with it. Kids can have ET; it’s not common, but it’s not rare either in clinic.
• Secondary or “something else is going on” tremor: From medical issues (hyperthyroidism, low blood sugar, electrolyte shifts), neurological problems (cerebellar injury, Wilson disease), toxins (heavy metals), or functional/psychogenic tremor (real symptoms driven by how the nervous system handles stress and attention). These need a clinician’s eye.

A quick way to map what you’re seeing:

• Does it shake at rest? Resting tremor in kids is uncommon and leans neurologic or medication-induced parkinsonism - worth a medical review.
• Does it shake with posture or action? More often benign, ET, or trigger-related. Think energy drinks, anxiety before a recital, fever day, or after an asthma puffer.
• Is it fast and fine, or slow and big? Fast and fine (8-12 Hz) favors physiologic/enhanced; slow and intent-based (worse as the finger nears a target) points to cerebellar involvement - doctor time.

For context and a plan-at-a-glance, here’s a compact map of common causes, clues, and first steps.

Two quick real-life clues I’ve used at the kitchen bench: my son’s hands shook after a double espresso mocha he should never have had - classic caffeine-enhanced tremor; it settled once he ate and hydrated. My daughter’s shaky writing after a big day and not much lunch? Fixed by dinner and sleep. These aren’t diagnoses, but they remind you to check the simple stuff first.

What about seizures? Tremor is rhythmic and usually preserves awareness and control; seizures are often not suppressible, may bring staring, confusion, or post-event sleep. If you’re unsure, film it and show your doctor - videos often crack the case.

What to do right now: step-by-step checks, when to worry, and what doctors do

If your child is shaking today, work through this in order.

1. Safety first. If there’s confusion, severe headache, weakness, trouble walking, a head injury, fever with stiff neck, vomiting, or the tremor is spreading and fast - seek urgent care. Trust your gut.
2. Quick home checks (10 minutes).
   • Hydration and fuel: give water and a snack with protein + carbs (e.g., yoghurt and a banana).
   • Temperature: if febrile, give fever-reducing meds you normally use and re-check after 30-60 minutes.
   • Caffeine and decongestants: pause energy drinks/coffee and cold-and-flu tablets with stimulants.
   • Medicines: has there been a new dose or change? Salbutamol commonly causes transient tremor. Do not stop essential meds; call your GP if it’s disruptive.
   • Breathing: slow nasal breaths (4 in, 6 out) for 2-3 minutes; anxiety-driven tremor often softens.
   • Film a 20-30 second clip: hands outstretched, then finger-to-nose. Capture both sides and the face.
3. Spot the pattern. Is it there at rest? Worse when reaching? One-sided or both? Any triggers (stress, sport, hunger)? Interfering with eating, writing, or buttons? Note it.
4. Book your GP if it persists beyond a few days, recurs, or interferes with life. Bring your notes and the video.

What your GP will usually do (and what you can expect in Australia in 2025):

• History: onset, triggers, family history of tremor or thyroid disease, meds/supplements (including pre-workout powders), caffeine use, illness, injury, school impact.
• Exam: rest vs postural vs action tremor; balance and coordination; strength and reflexes; eye movements; thyroid signs; a quick spiral drawing test.
• Basic tests if indicated: blood glucose (if suspected lows), electrolytes, calcium/magnesium, thyroid (TSH, free T4), liver function; in older kids with red flags or odd features, copper and ceruloplasmin for Wilson disease. Imaging (MRI) is reserved for focal signs, imbalance, or progressive change.
• Referrals: paediatric neurology for unclear or impactful tremor; endocrinology for thyroid; psychology/physio for functional tremor; occupational therapy for school and daily skills.

Credible guidance behind these steps includes the American Academy of Neurology’s evidence statements on essential tremor management, Royal Children’s Hospital (Melbourne) clinical practice guidance on movement symptoms, BMJ Best Practice, and UpToDate 2025 summaries on paediatric tremor. The thread across all of them: start with careful history and exam; test only when the story or exam points you there.

Red flags checklist - if any are present, seek urgent care:

• New tremor after head injury or with severe headache, vomiting, or neck stiffness
• Tremor with weakness, slurred speech, vision loss, or trouble walking
• Altered behaviour or confusion
• Rapidly worsening tremor, or tremor spreading body-wide
• Weight loss, racing heart, heat intolerance (possible hyperthyroidism) with a marked tremor
• Known diabetes with sweating, shakiness, and confusion that doesn’t improve after a quick snack

A quick rule of thumb many paediatricians use: a symmetric, fine hand tremor that appears with outstretched arms, after stress, caffeine, or albuterol, and eases at rest is usually enhanced physiologic tremor. A larger, target-worsening tremor with imbalance deserves imaging and specialist review.

Treatments, home fixes, and long-term support that actually help

The goal isn’t “no tremor ever.” It’s “my child can eat cereal, write legibly, and feel confident.” Here’s how we get there.

Start with the cause

• Enhanced physiologic/triggered: sleep, nutrition, hydration, and stress management are the big levers. Cut down caffeine; space asthma puffs as prescribed; ask your GP if a spacer and technique check could reduce tremor from inhalers.
• Medication-induced: don’t stop a necessary medicine, but do ask the prescriber about dose timing, extended-release options, or alternatives. For stimulants, taking the dose after breakfast can reduce shakiness for some kids.
• Metabolic: fix the underlying issue - glucose stability in diabetes, correcting low calcium/magnesium, treating infections.
• Endocrine: treating hyperthyroidism often resolves the tremor; your GP will guide referral to paediatric endocrinology.
• Functional tremor: reassurance plus targeted physiotherapy and psychology (CBT/ACT) that focus on retraining movement and dampening the threat response. These are evidence-based and child-friendly.

When it’s essential tremor

Essential tremor in kids usually shows up in the hands with posture/action and can affect writing, eating, and instruments. The American Academy of Neurology supports beta-blockers (like propranolol) and primidone as effective options in adults, with paediatric use guided by specialists; topiramate is another option used in select cases. Doctors weigh side effects (fatigue, low mood, asthma for beta-blockers; sedation or appetite issues for others) against the benefits. Medication is reserved for tremor that genuinely impairs daily function.

Occupational therapy (OT) is your quiet superpower

• Handwriting: thicker pencils, pencil grips, or a weighted pen; writing on a slanted surface; short writing bursts with breaks.
• Eating: heavier cutlery, a non-slip mat under bowls, two-hand cups with lids.
• School supports: extra time for exams, typing options, printing instead of cursive, don’t penalise for shaky handwriting. In Australia, schools can set these supports without a full diagnostic label if function is affected.

Simple daily routine that reduces tremor intensity

• Sleep: protect 9-12 hours (age-dependent). Tremor loves fatigue.
• Fuel: breakfast with protein (eggs, yoghurt, nut butter) and a snack before fine-motor heavy tasks.
• Hydration: a water bottle that actually gets emptied - aim for pale yellow urine.
• Stimulants: limit caffeine and pre-workout powders; check cold/flu tablets for pseudoephedrine/phenylephrine.
• Breathing drills before “shaky” moments: box breathing (4-4-4-4) for 1-2 minutes.

What not to do

• Don’t shame the shaking or make it a constant topic - anxiety ramps tremor.
• Don’t stop essential medicines on your own. Adjustments should be supervised.
• Don’t chase random supplements. Evidence for magnesium/B-complex for tremor is weak unless there’s a deficiency.

When treatments get more specialised

• Botulinum toxin: can help head or voice tremors in selected cases via specialist teams.
• Deep brain stimulation (DBS): rarely used in children, reserved for severe, refractory tremor under paediatric movement disorder experts.

Evidence notes: The AAN guideline update on essential tremor supports propranolol and primidone for limb tremor; paediatric data are smaller, but practice mirrors adult evidence with careful dosing and monitoring. Occupational therapy and school accommodations show consistent functional gains in cohort studies and clinical practice. Functional tremor benefits from multidisciplinary approaches; this is reflected across AAN statements, BMJ Best Practice, and paediatric FND programs in Australia.

Parent cheat sheet you can save

• Track: what triggers it, when it happens, rest vs action, impact at school/home.
• Film: 20-30 seconds with arms out and finger-to-nose, both sides.
• Fix the basics: sleep, hydration, food, caffeine, anxiety tools.
• Ask at the GP: “Could this be enhanced physiologic tremor, essential tremor, or medication-related?” and “Which tests, if any, do we need?”
• Request supports: OT referral and school accommodations if writing/eating are affected.

Citations you can mention at appointments: American Academy of Neurology (Essential Tremor guideline), Royal Children’s Hospital Melbourne (movement disorders guidance), UpToDate (Tremor in children, 2025), BMJ Best Practice (Tremor), International Parkinson and Movement Disorder Society (definition).

SEO note for clarity: this guide focuses on tremors in children - rhythmic shaking - not tics or seizures.

Mini‑FAQ

• Is my child’s tremor a seizure? Seizures often bring altered awareness, staring, or jerking that doesn’t stop with distraction. Tremor is rhythmic and your child can usually follow commands while it happens. If you’re unsure, seek medical advice and bring a video.
• Can vitamin deficiency cause shaking? True vitamin-driven tremor is uncommon. Severe B12 deficiency can cause neurological signs, but tremor is not a typical first clue. Your GP can test if there are dietary concerns.
• Does screen time cause tremor? No direct link. But too much screen time can disrupt sleep, and poor sleep can amplify a natural tremor.
• Will my child outgrow it? Trigger-driven tremor usually settles when the trigger does. Essential tremor tends to persist, but it’s manageable, and many kids lead fully active lives with simple supports.
• Should we stop ADHD meds? Don’t stop on your own. Tremor can sometimes improve with a dose tweak or timing change; your prescriber can adjust safely.
• Could it be Parkinson’s? Parkinson’s disease is exceptionally rare in children. A resting tremor with stiffness and slowness from certain medicines can look “parkinsonian,” which is reversible by adjusting the drug.
• What tests are really needed? Many kids don’t need any. Tests are guided by the story and exam - thyroid, electrolytes, glucose first; copper studies or imaging only when red flags or specific signs appear.

Next steps and troubleshooting by scenario

• Toddler after a fever day: give fluids and food, treat fever as usual, wait an hour. If shakiness settles and your child is playful, monitor. If persistent with lethargy or confusion, seek care.
• School‑age child with shaky handwriting: video the tremor, ask the teacher about triggers (fatigue, stress), try a thicker pencil and short writing bursts. Book GP if it’s new, worsening, or impacting learning.
• Teen athlete using pre‑workout + coffee: stop stimulants for a week, prioritise sleep and hydration, and reassess. If the tremor persists, see your GP.
• Child with asthma on salbutamol: tremor can be a common side effect. Check inhaler technique and spacer use; discuss dose intervals with your GP. Do not reduce needed doses without advice.
• Family history of essential tremor: keep a diary and short videos; ask your GP about referral to paediatric neurology and occupational therapy; request school supports early.

If you remember just one map: simple triggers first, red flags second, then precise diagnosis and tailored support. That sequence is fast, safe, and kinder to everyone’s nerves - yours included.