Author name: Dr. Nikhil Pawar

When parents hear that their child may have ADHD, one of the first questions is often, “Should we start medicine or therapy?” It is a reasonable question. Parents naturally want to choose the safest and most effective option without making their child dependent on treatment unnecessarily. At the same time, they may worry about school performance, behaviour, confidence, friendships and the child’s future. There is no universal answer that applies to every child. ADHD can look very different from one child to another. A preschool child who is constantly running, climbing and struggling with transitions has different developmental needs from a 10-year-old who cannot complete schoolwork. A teenager who understands the lessons but cannot organise assignments or control impulsive behaviour may need a different approach again. This is why ADHD medication vs behavioral therapy should not be treated as a simple competition between two treatments. The right approach depends on the child’s age, symptom severity, functional difficulties, family circumstances, school environment and the presence of other developmental or emotional concerns. A useful way to think about treatment Do not begin by asking: “Which treatment is better for ADHD?” Begin by asking: “Which difficulties are interfering most with my child’s daily life, and what treatment can address them?” What Good ADHD Care May Support Better attention and task completion Improved impulse control Reduced disruptive or unsafe behaviour Better school participation More organised routines Improved parent-child interactions Greater emotional regulation Better homework and study habits Improved independence with age Stronger participation in family and social activities The aim is not to make a child behave like everyone else. Good ADHD care should help the child use their abilities more effectively while developing practical skills for everyday life. Start With a Careful ADHD Assessment Before choosing medication or behavioural therapy, it is important to establish whether the child’s difficulties are actually due to ADHD. Children can have problems with concentration, restlessness or behaviour for many different reasons. For example, attention may be affected by: Poor or irregular sleep Anxiety Learning difficulties Hearing or vision problems Autism Speech and language difficulties Emotional stress Excessive screen use Classroom difficulties Family or environmental changes Other developmental or neurological conditions ADHD diagnosis is therefore not simply based on a child being active or inattentive. A proper evaluation considers symptoms across different settings, their duration, developmental history and their impact on functioning. A Pediatric Neurologist in Nashik can help assess developmental and neurological concerns when parents need a more detailed clinical evaluation. Depending on the child, assessment may include: Detailed developmental history Behavioural and attention assessment School feedback Parent questionnaires Evaluation of academic functioning Assessment of language and learning Review of sleep and daily routines Screening for anxiety or mood concerns Assessment for autism when indicated Neurological examination when clinically appropriate The purpose is not to attach a label quickly. It is to understand what is actually making everyday life difficult for the child. Build the Treatment Plan Around Functional Needs A treatment plan should focus on what the child needs help with rather than simply adding as many interventions as possible. Main difficulty Possible treatment priority Severe impulsivity affecting safety Behavioural strategies and possible medication assessment Poor classroom attention School support and ADHD treatment Difficulty completing homework Organisation strategies and behavioural support Frequent parent-child conflict Parent training and behaviour management Significant hyperactivity Environmental strategies and possible medication Anxiety alongside ADHD symptoms Assessment and appropriate psychological support Learning difficulty Educational assessment and academic intervention Poor sleep Sleep assessment and routine correction This approach prevents treatment from becoming a collection of disconnected appointments. A child does not automatically need every available therapy simply because ADHD has been diagnosed. Behavioural Therapy for ADHD Behavioural therapy is an important part of ADHD care, particularly for younger children. It does not mean repeatedly telling the child to “behave properly.” Instead, it teaches parents, caregivers, teachers and children practical ways to manage behaviours and build useful habits. Behavioural strategies may include: Positive reinforcement Reward systems Clear household rules Consistent consequences Visual routines Breaking tasks into smaller steps Reducing unnecessary distractions Providing short and clear instructions Giving immediate feedback Building predictable transitions One important part of behavioural intervention is helping parents respond consistently. A child with ADHD may need several reminders before completing a task. Long explanations or repeated criticism often do not solve the underlying attention or impulse-control problem. A short instruction, clear expectation and immediate positive feedback can be much more useful. Parent Training Is Part of ADHD Treatment Parents sometimes hear “behavioural therapy” and assume the child must attend therapy sessions alone. For younger children, parent training can be particularly important. Parents can learn how to: Give one instruction at a time Establish predictable routines Reward desired behaviour Reduce unnecessary arguments Use consequences consistently Break difficult activities into smaller steps Prepare children before transitions Encourage positive behaviour instead of focusing only on mistakes This does not mean parents are responsible for causing ADHD. Rather, parents are in a unique position to make the home environment more predictable and supportive. The same principles can also be adapted for school. What ADHD Medication Does ADHD medicines are designed to reduce core symptoms such as inattention, hyperactivity and impulsivity. When the right medication and dose are selected for an individual child, treatment may make it easier to: Concentrate during lessons Complete tasks Follow instructions Remain seated when required Control impulsive responses Organise schoolwork Participate more effectively in structured activities Medication does not teach every skill a child needs. A medicine may improve the child’s ability to focus, but the child may still need help learning how to plan homework, organise a school bag, manage emotions or develop social skills. This is one reason medication should be considered as part of an overall treatment plan rather than as the entire plan. Stimulant and Non-Stimulant ADHD Medicines ADHD medications are broadly divided into stimulant and non-stimulant categories. Stimulant medicines Stimulant medications are commonly used for ADHD and can be effective in reducing attention and hyperactivity-impulsivity

Dr Nikhil Pawar A Practical Daily Routine for Children Parenting a child with ADHD can make everyday routines surprisingly challenging. Getting ready for school, remembering books, completing homework, sitting through meals and settling down at bedtime may lead to repeated reminders and frustration. These difficulties are not simply because a child is careless, stubborn or poorly disciplined. ADHD can affect attention, impulse control, organisation, time management and the ability to move smoothly from one activity to another. A good ADHD treatment plan at home is therefore not about creating a rigid timetable. The goal is to make everyday tasks more predictable, reduce unnecessary distractions and provide support where the child needs it most. Home strategies work best alongside appropriate medical assessment, behavioural support and school interventions when required. Why Do Children With ADHD Benefit From a Routine? Children with ADHD may find it difficult to remember several instructions at once, estimate how long a task will take, organise belongings, start an uninteresting task, remain focused until a task is completed, shift from one activity to another, and control impulses or emotional reactions. A predictable routine reduces the amount of planning a child has to do independently. Instead of repeatedly wondering, “What am I supposed to do next?”, the child can follow a familiar sequence. Keep routines: Visible: Use a checklist, whiteboard or picture schedule. Short: Break larger tasks into small steps. Predictable: Keep important routines reasonably consistent. Flexible: Allow for holidays, examinations, illness and family events. Positive: Include play, exercise, hobbies and family time – not only work. A Practical Daily ADHD Routine Morning → School → Decompress → Homework → Physical activity/play → Bedtime 1. Morning Routine A successful morning often begins the night before. Keep the school uniform, shoes, school bag, books and water bottle in designated places. For younger children, use a picture checklist. Older children can use a short written checklist. For example: Wake up → Brush → Dress → Breakfast → Bag check → Shoes → Leave. Give one instruction at a time rather than several instructions together. Instead of “Get dressed, eat breakfast, pack your bag and don’t forget your project,” try: “Please put on your uniform.” Once that is completed, move to the next step. Timers and transition warnings can also help: “We leave in 10 minutes,” followed by “Five minutes left.” Praise specific behaviours whenever possible, such as: “You checked your timetable and packed your bag without a reminder.” 2. Organise School Materials Create a fixed place for school belongings. Depending on the child’s age, consider separate folders or trays for homework, school notices, completed work and books that need to return to school. Before leaving home, use a short checklist containing the items the child most frequently forgets. Avoid introducing a very long checklist immediately. Start with two or three important items and expand gradually. 3. Allow an After-School Transition Some children with ADHD have spent much of their school day working hard to sit still, listen and regulate their behaviour. Starting homework immediately after arriving home may therefore create unnecessary conflict. A predictable transition can help: Come home → Wash/change → Snack and water → Short rest or physical activity → Homework. The break should have a clear beginning and end. If television, mobile phones or gaming are allowed during this period, decide the duration beforehand. Highly engaging screen activities can sometimes make the transition back to homework more difficult. 4. Make Homework ADHD-Friendly The goal should be a specific, achievable task. Instead of “Finish your homework,” say: “Complete questions 1-5.” Keep only the books and stationery required for the current task on the table, and reduce unnecessary television, mobile notifications and other distractions. Many children benefit from a pattern of: short work period → brief movement break → next work period. The appropriate duration varies with the child’s age, attention span, sleep, task difficulty and treatment response. Movement breaks can include walking, stretching, drinking water, a short physical activity or a simple household task. Avoid starting an exciting game or video during a brief break if stopping it is likely to become another battle. If the child loses focus, use a short neutral cue such as “Back to question three.” Long lectures usually do not improve attention. If written work is consistently slow, consider why. Difficulty may result from poor attention, handwriting problems, language difficulties, learning difficulties, planning problems or excessive workload. The solution depends on the cause. 5. Use Positive Behaviour Support Choose only one or two behaviours at a time, such as beginning homework within 10 minutes, keeping shoes in the designated place, completing the morning checklist or waiting for a turn during conversation. For younger children, a simple star or point system may help. Rewards do not need to be expensive. They might include choosing a family game, extra playtime, selecting the bedtime story or helping prepare a favourite activity. Keep rules short and positive. Consequences should be calm, proportionate and explained beforehand. Avoid physical punishment, humiliation and repeated threats. They may increase conflict without teaching the child the skill you actually want them to develop. 6. Protect Sleep Poor sleep can worsen attention, irritability and impulse control. Create a predictable sequence such as: Dinner → Prepare school bag → Hygiene → Quiet activity/reading → Bed. Try to keep bedtime reasonably consistent. Avoid extending homework late into the night simply because work remains incomplete. In many situations, protecting sleep is more useful than forcing a tired child through another prolonged study session. If you are looking for a Child Neurologist in Nashik, discuss your child’s complete developmental and school history rather than relying on isolated behaviours or online checklists. For families also learning about developmental conditions, reliable guidance on Autism Treatment can help explain why assessment and intervention must be tailored to the child rather than based on a single symptom. Work With the School Home strategies cannot replace appropriate educational support. With the family’s consent, discuss the child’s difficulties with the teacher or school

Dr Nikhil Pawar Seizures in Children When to See a Pediatric Neurologist and What Tests Are Needed   A practical guide for parents A seizure does not always look like full-body shaking. Some children stare, become briefly unresponsive, make repetitive movements, suddenly fall, or behave unusually. Knowing what to observe – and what to do – can make the evaluation safer and more accurate. Seeing a child suddenly become unresponsive, stiff, shake, stare blankly, or make unusual movements can be frightening. Parents usually want to know three things immediately: Was this a seizure? Is my child in danger? Does this mean epilepsy? A seizure is a temporary disturbance of brain electrical activity that can affect movement, awareness, behaviour, sensation, or a combination of these. Importantly, one seizure does not automatically mean epilepsy. Fever, metabolic disturbances, infection, head injury and other acute problems can provoke seizures, while some children may have recurrent unprovoked seizures that require further neurological evaluation. What exactly is a seizure? A seizure occurs when there is a sudden episode of abnormal electrical activity in the brain. Because different brain regions control different functions, seizures can look very different from one child to another. Stiffening or rhythmic jerking of part or all of the body Sudden loss or alteration of awareness Blank staring with failure to respond Eyes or head turning to one side Sudden falls or loss of muscle tone Repetitive movements such as lip-smacking, chewing, picking or fumbling Temporary inability to speak or respond Unusual sensations, fear, confusion or behaviour Some seizures are subtle. Recurrent episodes in which a child abruptly stops an activity, becomes unresponsive for a few seconds and then resumes may be mistaken for daydreaming. The stereotyped, repeated pattern of an event is often an important clue. Does one seizure mean epilepsy? No. A seizure is an event; epilepsy is a neurological disorder characterised by an enduring predisposition to recurrent unprovoked seizures. The diagnosis depends on the clinical history and, when appropriate, EEG, imaging and other investigations. A seizure may occur in association with fever, low blood glucose, electrolyte disturbances, infection, medication or toxin exposure, acute brain injury, or another temporary trigger. Conversely, an unprovoked seizure may sometimes be the first presentation of an epilepsy syndrome. Key message Do not label a child as having epilepsy simply because one episode of shaking or unresponsiveness has occurred. The circumstances and semiology of the event matter. What can cause seizures in children? The likely causes vary with the child’s age, development, medical history and seizure type. Important categories include: Fever: febrile seizures occur in some young children during a febrile illness. Genetic factors: some epilepsy syndromes have a genetic basis even when neither parent has epilepsy. Structural or developmental brain conditions: cortical malformations, previous brain injury and other structural abnormalities may increase seizure risk. Central nervous system infection: meningitis, encephalitis and related illnesses can present with seizures. Head injury: significant traumatic brain injury may be associated with acute or later seizures. Metabolic disturbances: abnormalities of glucose, sodium, calcium and other metabolic parameters can provoke seizures. What should parents do during a convulsive seizure? The immediate priority is safety. Move sharp, hard, hot or dangerous objects away from the child. Protect the head with something soft if possible. Do not restrain the child’s movements. Do not force the mouth open and do not put fingers, spoons, cloth, food, water or medicine into the mouth. Time the seizure from the beginning. When feasible and safe, position the child on the side, particularly as the convulsion settles, to help maintain a clear airway. Stay with the child and observe breathing and recovery. Never put anything in the mouth A child cannot “swallow the tongue”. Putting an object or fingers into the mouth can cause dental injury, aspiration or injury to the caregiver. When is a seizure an emergency? Seek urgent emergency medical care when: A convulsive seizure lasts 5 minutes or longer, or continues beyond the child’s prescribed emergency plan. Another seizure begins before the child has recovered. The child has difficulty breathing, persistent cyanosis, or does not recover as expected. There is serious injury. The seizure occurs in water. The child is severely ill or has concerning neurological symptoms such as new weakness or persistent altered consciousness. The treating clinician has advised emergency assessment because of the child’s age, underlying condition, or seizure pattern. A first suspected seizure should be medically assessed. Whether it requires an ambulance or emergency department evaluation depends on the event, recovery and clinical context. Why a mobile-phone video can be extremely helpful If the child is safe and emergency care is not being delayed, a video can provide valuable diagnostic information. Try to capture the whole child and, if possible, the face and eyes. How the episode started Eye or head deviation Which body part moved first Whether movements were symmetrical Whether the child responded to name or touch Approximate duration Behaviour immediately after the event Never delay first aid or emergency care simply to obtain a video. When should a child see a pediatric neurologist? Specialist assessment is particularly useful when: Seizures or unexplained episodes happen more than once Events occur without an obvious acute trigger There are recurrent staring or unresponsive spells Episodes include stereotyped automatisms or unusual movements with impaired awareness Seizures arise during sleep There are developmental concerns or loss of previously acquired skills There is new weakness, imbalance or change in walking The neurological examination is abnormal The episodes are increasing in frequency or changing in pattern The diagnosis remains uncertain and seizure mimics need to be considered What happens during a pediatric neurology consultation? The most important “test” is often a careful history. The Pediatric Neurologist reconstructs the event from beginning to end and considers the child’s age, development and neurological examination. Pregnancy, birth and developmental history Fever or illness around the event Previous seizures, head injury or neurological illness Medication exposure and sleep pattern Family history of seizures or neurological disorders School performance and

Dr Nikhil Pawar Consultant Pediatric Neurologist, Nashik   Autism does not have one standard therapy package or a quick cure. The right plan is built around the child’s most important functional needs, clear goals, family priorities and regular review.   Autism Treatment: What It Really Means Hearing the word autism in relation to your child can feel overwhelming. Families are often exposed to conflicting advice: start speech therapy, begin behaviour therapy, try sensory treatment, wait and watch, change the diet, or purchase an expensive “complete programme.” The result is often confusion, guilt and an overloaded schedule. Autism is a neurodevelopmental condition. It affects social communication, patterns of behaviour, sensory experience, learning and day-to-day adaptability in different ways in different children. Therefore, treatment should not aim to make every child look or behave the same. It should help the child communicate, participate, learn, regulate emotions, develop independence and remain safe. A useful way to think about treatment Do not begin by asking, “Which therapies should my child take?” Begin by asking, “What is the biggest barrier in my child’s daily life right now?” What Good Autism Care May Support Functional communication – spoken words, gestures, pictures or an AAC device Shared attention, interaction, play and participation Understanding language and expressing needs Emotional regulation, flexibility and transitions Feeding, dressing, toileting, sleep and other daily routines Attention and readiness to learn School participation and peer interaction Parent confidence and practical home strategies Start With a Developmental and Medical Assessment A therapy plan is stronger when it follows a careful assessment rather than a pre-decided package. The evaluation should identify the child’s strengths, developmental level, communication profile, behaviour triggers, sensory needs, adaptive skills and school functioning. It should also look for associated medical or developmental conditions that may affect progress. Depending on the child, assessment may include: Hearing assessment, particularly with speech delay or inconsistent response to sound Vision assessment when clinically indicated Developmental, language and cognitive evaluation Assessment for ADHD, anxiety, intellectual disability and learning difficulties Review of sleep, feeding, nutrition, constipation and toileting Neurological assessment when there are seizures, regression, unusual movements, weakness or imbalance Genetic evaluation when clinically indicated Review of family routines, school environment and caregiver priorities Intervention for clear developmental difficulties should not be unnecessarily delayed while families wait for every assessment to be completed. However, therapy and medical evaluation should proceed in a coordinated manner. Build the Plan Around Functional Goals A child does not automatically need every available therapy. The first priority should be the difficulty that most affects communication, safety, learning or family life. Main difficulty Possible first priority Cannot request basic needs Functional communication using speech, gesture, pictures or AAC Frequent aggression during demands Functional behaviour assessment, easier communication and replacement skills Severe distress during grooming or feeding OT/feeding assessment linked to specific daily-life goals Limited reciprocal play and shared attention Developmental social-communication intervention Hyperactivity prevents participation Review sleep, environment, communication demands and possible ADHD School refusal or daily classroom distress School observation, accommodations, visual structure and sensory/environmental changes Good goals are observable and measurable Examples: requests five daily needs independently; tolerates tooth-brushing for two minutes; follows a visual routine for school; reduces self-hitting during transitions; joins a turn-taking game for three exchanges. Evidence-Based Intervention Options 1. Developmental Social-Communication Intervention These approaches build communication and social learning through play, interaction and everyday activities. They may work on shared attention, imitation, turn-taking, engagement, flexible play and functional language. The style should match the child’s developmental level and should involve parents, caregivers and teachers where possible. The aim is not forced performance. It is more comfortable, meaningful and spontaneous participation with other people. 2. Speech and Language Therapy Speech and language therapy may be helpful when a child has difficulty understanding language, expressing needs or using communication socially. Communication is broader than spoken vocabulary. Receptive language – understanding words, instructions and questions Functional expression – asking, refusing, choosing, requesting help and sharing interest Gestures, pointing and joint communication Pragmatic language – using language appropriately in social situations Parent strategies that can be used during meals, play, dressing and travel Important Reciting alphabets, rhymes or memorised dialogues is not the same as functional communication. Therapy should improve the child’s ability to communicate meaningfully in real situations. 3. AAC: Communication Beyond Spoken Speech Some children need Augmentative and Alternative Communication (AAC), temporarily or long term. AAC may include picture cards, communication boards, visual choices, signs, speech-generating devices or apps. Using AAC does not mean giving up on speech. Appropriate AAC often reduces frustration and gives the child a reliable way to express needs, choices, discomfort and emotions while spoken language continues to be encouraged when possible. 4. Parent-Mediated Intervention Parents do not need to become full-time therapists. They do need to understand how to create communication opportunities, use simple language, support transitions, respond to meltdowns and reinforce new skills in ordinary family routines. This greatly increases the child’s opportunities to practise skills outside the therapy room. Use everyday play and routines as learning opportunities Break tasks into manageable steps Use visuals and predictable transitions Notice the function of behaviour before reacting Reinforce communication and adaptive skills consistently 5. Behavioural Support Behavioural approaches can be useful when they are ethical, individualised and focused on function. Good behavioural care asks why a behaviour occurs and teaches a safer, more effective replacement skill. For example, if a child throws objects when a task begins, the team should ask whether the task is too difficult, the instruction is unclear, the environment is overwhelming, or the child lacks a way to request a break. What should not be the goal Forced eye contact, passive compliance or prolonged sitting without meaningful learning. Better goals include shared attention, functional communication, participation, safety, play and independence. 6. Occupational Therapy for Defined Functional Needs Occupational therapy can be helpful when a child has specific difficulties with self-care, fine-motor skills, feeding, dressing, handwriting readiness, play, motor coordination or participation in daily routines. Sensory differences may contribute to distress

For many parents, it starts with a small doubt. A toddler who still doesn’t respond to their name. A school-going child who keeps falling behind, even though they seem bright. A baby whose body feels unusually stiff or floppy. A child who has repeated staring spells that are brushed off as “daydreaming.” Sometimes there is no dramatic emergency—just a growing feeling that something is not quite right. That is exactly why this topic matters. Parents are usually the first people to notice subtle changes in a child’s behaviour, movement, learning, speech, or development. But not every concern clearly looks like a “brain problem” or “neurology issue.” Many neurological conditions in children do not begin with obvious seizures or major weakness. They can show up as delayed speech, unusual movements, poor eye contact, imbalance, headaches, regression of milestones, attention issues, or changes in school performance. Because these signs can overlap with common childhood phases, parenting stress, school adjustment issues, or behavioural concerns, families often wait too long before seeking the right specialist. A pediatric neurologist is a doctor who evaluates conditions related to the child’s brain, spinal cord, nerves, muscles, development, seizures, movement, and certain behaviour-linked neurological conditions. Knowing when should you see a pediatric neurologist for your child can help you avoid unnecessary delays, get the right testing at the right time, and begin support earlier if needed. This blog explains 7 warning signs parents often miss, what they may mean, when to seek help urgently versus routinely, and how to think about neurological symptoms without panic—but without ignoring them either. Why Neurological Symptoms in Children Are Easy to Miss Children are constantly growing, changing, and developing at different speeds. That makes it surprisingly hard to tell what is normal variation and what may need medical attention. A few reasons parents may miss early neurological warning signs include: They assume “every child develops at their own pace” Family members reassure them that boys speak late or shy children avoid eye contact School complaints are blamed only on discipline or screen time Repetitive movements are mistaken for habits Headaches, clumsiness, or poor concentration are dismissed as stress A child’s symptoms come and go, so the issue feels less serious Parents are worried about overreacting It is true that not every late talker has a neurological disorder and not every tantrum means autism or ADHD. But when a concern is persistent, progressive, unusual, or affecting daily functioning, it deserves a closer look. What Does a Pediatric Neurologist Actually Treat? A pediatric neurologist does not only see children with seizures. They evaluate a wide range of conditions involving the nervous system and neurodevelopment. These may include: Seizures and epilepsy Developmental delay Autism spectrum disorder concerns ADHD when neurological evaluation is needed Speech delay linked with developmental or neurological concerns Cerebral palsy Muscle weakness or floppy child symptoms Frequent headaches or migraines Tics and abnormal movements Balance problems and gait issues Regressive milestones Learning or behavioural concerns linked to brain development Sleep-related neurological issues Genetic or metabolic neurological disorders So if your child’s problem involves development, movement, coordination, repeated unexplained episodes, or possible brain–nerve involvement, a neurology opinion may be relevant. 7 Warning Signs Parents Often Miss 1) Developmental Milestones Are Consistently Delayed or Skills Are Not Progressing This is one of the most common and most overlooked reasons to consult a pediatric neurologist. Every child develops at their own pace—but only within a broad expected range. A child who is delayed in multiple developmental areas, or who is clearly not catching up over time, needs proper evaluation. Delays that deserve attention include: Not sitting, standing, or walking around expected age ranges Delayed speech and language development Poor understanding of simple instructions for age Difficulty using hands well, such as grasping, stacking, or self-feeding Lack of social milestones such as pointing, imitation, or shared attention Trouble with coordination compared with peers When it becomes more concerning It becomes especially important to seek evaluation if: The delay is seen in more than one domain—speech, motor, social, or cognitive The gap between your child and same-age peers is increasing Teachers or caregivers have raised repeated concerns The child had a normal start but progress has slowed significantly There are associated issues like poor eye contact, stiffness, floppy muscles, or unusual repetitive behaviour A developmental delay does not automatically mean a serious neurological disease. Sometimes it may be related to hearing issues, prematurity, speech-language delay, autism, ADHD, low stimulation, or learning differences. But the role of a neurologist is to help identify whether the pattern suggests an underlying brain, nerve, developmental, genetic, or seizure-related cause. Parents who are unsure whether a delay is “just late blooming” often benefit from an evaluation with a Consultant Pediatric Neurologist in Nashik when progress is clearly lagging or multiple milestones are affected. 2) Your Child Has Staring Spells, Sudden Jerks, Unusual Episodes, or Possible Seizures When people think of seizures, they usually imagine full-body shaking. But seizures in children can be much subtler than that. Possible seizure-like events may include: Repeated blank staring with no response for a few seconds Lip smacking, chewing movements, or repeated blinking during episodes Sudden jerks of arms or body, especially on waking Body stiffening spells Unexplained falls Recurrent episodes of confusion Sudden pause in activity followed by normal behaviour Night-time episodes with unusual movements, stiffening, or bedwetting in an older child Not every unusual episode is a seizure. Children may daydream, zone out, faint, have reflux episodes, breath-holding spells, tics, or sleep-related movements. But if an event is repetitive, stereotyped, brief, unexplained, or associated with loss of awareness, it should not be ignored. Red flags that make urgent evaluation more important The child turns blue, becomes stiff, or shakes There is tongue bite, loss of bladder control, or prolonged sleep afterwards The episode lasts more than 5 minutes There are repeated events in one day The child has fever and a first-time seizure There is head injury, weakness, or confusion after the event Whenever