[Tremor]

Tremor is one of the most common movement disorders encountered in pediatric clinical practice and encompasses a broad spectrum of clinical presentations, etiologies, and outcomes. It is defined as an involuntary, rhythmic, oscillatory movement, and its evaluation in childhood is challenging due to phenotypic variability, limited standardization of complementary studies, and reliance on clinical observation. These recommendations from the Ibero-American Academy of Pediatric Neurology (AINP) aim to provide a practical and updated approach to the classification, diagnostic evaluation, treatment, and prognosis of tremor in pediatric patients. The two-axis classification proposed by the International Parkinson and Movement Disorder Society is adopted, distinguishing clinical phenotype from underlying etiology. The main forms of tremor observed in neonates, children, and adolescents are reviewed, including benign developmental tremors, tremors secondary to neurological, metabolic, genetic, pharmacological, and functional disorders, as well as specific syndromes such as essential tremor, dystonic tremor, and cerebellar tremor. Indications for complementary studies, including laboratory testing, neuroimaging, neurophysiology, and genetic testing, are discussed, emphasizing their use in the presence of clinical red flags. Treatment should be individualized according to etiology and functional impact, prioritizing non-pharmacological interventions and reserving pharmacological and invasive therapies for selected cases. Overall, many pediatric tremors have a benign course; however, early etiological recognition is essential to prevent sequelae and optimize prognosis.