The appearance of an infant shaking their head can cause immediate concern, but this behavior is very common in early childhood. For most parents, the action is a normal, temporary part of development as the child explores movement and seeks comfort. Understanding the context of the head shaking is key to determining if it is a harmless habit or a sign that a medical evaluation is needed. This article covers the range of causes, from typical developmental milestones to the rare instances where the movements are linked to a health concern.
Common, Benign Reasons for Head Movement
The majority of head shaking instances occur while an infant is awake, alert, and content, often serving a purpose related to learning or communication. As babies gain better control over their neck and shoulder muscles, typically starting around four to six months of age, they begin to practice and experiment with new movements. Shaking the head side-to-side is a form of motor exploration, allowing them to test their physical abilities and strengthen muscles for future milestones.
Infants also use head movement for self-soothing when they feel overwhelmed, tired, or are experiencing discomfort, such as teething pain. The repetitive motion provides a consistent sensory input that many find calming, much like sucking a thumb or rocking. These movements are generally brief, sporadic, and happen when the child is not fully engaged in an activity.
The movement can also be an early form of non-verbal communication, emerging before the child has the vocabulary to express themselves. By about 12 months, many infants begin to shake their head to signal “no” after observing this gesture from caregivers. Babies may also track interesting sounds by moving their head back and forth, especially when attempting to isolate the source of a sound in a noisy environment.
Head Rolling and Rhythmic Movement Disorders
A specific category of head movement involves rhythmic motions that frequently occur during the transition to sleep. These movements are categorized as sleep-related rhythmic movements and are generally physiological, transient phenomena in infants and toddlers. The condition, known as Rhythmic Movement Disorder (RMD), includes head rolling, head banging (jactatio capitis nocturna), and body rocking.
These rhythmic motions are most common as the infant is drowsy, falling asleep, or in light, non-rapid eye movement (NREM) sleep. The movements provide a self-regulating or comforting sensation, often theorized to mimic the feeling of being held or rocked. While these movements can be intense and look concerning, they do not typically require treatment unless they cause injury or significantly disrupt sleep.
Rhythmic Movement Disorder is distinct from a seizure because the movements are highly patterned, symmetrical, and tend to stop immediately if the child is fully awakened. These rhythmic movements occur in an estimated 59–67% of normally developing infants around nine months of age, with the frequency naturally decreasing as the child gets older.
Signs That Require Immediate Pediatric Attention
In rare instances, head shaking can be a symptom of an underlying medical issue, especially when it occurs alongside other signs of distress or illness. One common medical context is a painful ear infection, or otitis media, where a child may vigorously shake or tug at their head in an attempt to relieve pressure. If the head shaking is accompanied by fever, persistent crying, irritability, or fluid discharge from the ear, a medical evaluation is warranted.
Head movement that is involuntary, jerky, or asymmetrical may indicate a neurological concern, such as a seizure. Unlike RMD, seizure-related movements often involve a loss of consciousness, unresponsiveness, or unusual eye movements like staring or rapid side-to-side jerking. Movements that are not easily interrupted by engaging the child, or are paired with a sudden loss of developmental milestones, should prompt an immediate consultation with a healthcare provider.
Other serious accompanying symptoms include a sudden onset of head shaking after a fall or head trauma, or signs of severe illness like a high-pitched, continuous cry, extreme drowsiness, or difficulties with breathing. Any head shaking behavior that is sudden, forceful, and accompanied by a change in the infant’s typical demeanor, feeding habits, or level of alertness requires urgent medical attention.
How to Document and Discuss Head Shaking
When preparing to discuss head shaking with a pediatrician, providing specific details helps determine the cause and context of the behavior. The most useful information is a clear record of when the movements occur, specifically noting if the infant is awake, drowsy, or fully asleep.
Parents should track the duration and frequency of the episodes over several days. Noting any associated symptoms, such as fever, vomiting, unresponsiveness, or a change in appetite, is also valuable. To provide the most accurate description, a short video recording of the movement is helpful for the doctor, as it captures the precise nature and rhythm of the shaking.