Pediatric Movement Disorders - Tremor

Examination

The child is examined to determine which body parts are affected, as well as the frequency and amplitude of the tremor. The tremor is observed while the child is at rest, while holding a posture against gravity (e.g., as with the arms outstretched), and while reaching for targets. Tremor may be accentuated by attempting to drink from a nearly full cup of water. It may be difficult to distinguish myoclonic or dystonic tremor from "true" tremor. Frequently, the distinction depends upon whether or not other symptoms are present, such as dystonic posturing or stimulus sensitivity. In dystonic tremor, there is often a "null point" or a position of the joint at which the tremor disappears, and then reverses direction as the joint is moved farther. The child's strength must be assessed, as enhanced physiologic tremor may become more apparent if there is muscle weakness. Family history of tremor is important, as several types of tremor, myoclonus, or dystonia may be inherited. It is also important to look for medications or toxins that are known to cause tremor.