TREMORS
Tremors are the most common symptom of NAS. Tremors, trembling and jitteriness are the same. They are involuntary movements or shakes. Tremors are a sign of central nervous system irritability. They are most often seen in the upper extremities (arms, hands, face). Tremors can occur when you are disturbing the baby (touching them) and then when you are not touching them (undisturbed). As such, tremors may be disturbed and/or undisturbed. The presence of undisturbed tremors indicates more excessive irritation of the central nervous system. It is also important to note that if the baby is asleep, a few jerking movements of the extremities may be present; this is normal. Tremors can be a sign of impact on the central nervous system and there are interventions that can help your baby. Note that tremors can cause your baby to be irritable/cry more and to impact sleep causing them to wake up. Assisting your baby with some interventions suggested below can be helpful.
NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.
The SOOTHE Technique
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
Avoid fast movements or position changes for the baby.
Handle the baby gently and give the baby intention movements; place your hand on your chest every time before you pick them up.
Infant massage will help the central nervous and motor system to mature.
Make sure the baby is well supported when picking them up and holding them.
Swaddle your baby during handling (diaper changes, feeding etc.) to reduce Tremors. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
When doing face to face interaction it may be helpful to swaddle your baby to reduce tremors.
MEDICAL
Determine the root cause of the tremors with the help of your baby’s doctor.
Let your baby’s doctor know about the Tremors (it is helpful to let them know if they are disturbed and/or undisturbed tremors and if they are all over or in upper body or lower body) so they can do a thorough examination.
Change the babies position frequently to prevent skin abrasions.
Use soft clothing and swaddles
NURSING
Tell your Baby’s doctor about the Tremors. Ask if baby should see a child neurologist.
Infant massage is helpful for reducing Tremors.
Swaddling especially to calm when tremors create irritability. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Use of a pacifier to calm the infant can reduce tremors.
OCCUPATIONAL THERAPY
Infant massage can be very beneficial.
Swaddling during feeds, interaction and sleep will help with impact of tremors and will decrease excoriation of the skin. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Certain positions are more helpful to reduce Tremors: tummy time, swaddling. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
SPEECH PATHOLOGY
Be very aware of Tremors during FEEDs – use safety strategies; don’t give too much flow, pull the nipple out if having a hard time (so tremors don’t trigger choking)
It will help to teach them to use a pacifier. Sucking is very calming to the nervous system. You will need to teach them to use a pacifier when they are calmer so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.
Most importantly, read your babies cues to inform your strategy.