Infantile Tremor Syndrome in Modern Times

Infantile tremor syndrome (ITS) is a clinical syndrome of acute or gradual onset of mental and psychomotor changes, pigmentary disturbances of hair and skin, pallor, and tremors in malnourished children aged between 5 months and 3 years. It is a well-known entity, but the exact etiopathogenesis is still not known. Prospective observational study carried out in the Department of Pediatrics at Dr RPGMC Tanda, Kangra in Himachal Pradesh. Demographic, clinical, and laboratory profile of 25 children with the diagnosis of preinfantile and ITS was collected who were admitted from May 2014 to June 2015. Descriptive analysis was performed using SPSS 17 trial version. These children accounted for 0.5% of total pediatric admissions. Median, standard deviation age was 10, 3.1 months. Male to female ratio was 1.27:1. Cases were present throughout the year with two peaks observed in the months of May and November. This disease was found to be more common in higher birth order (68%). Complementary feeding, that too improper, was initiated in only 4 cases (16%). Ninety-six percent cases presented with comorbid illnesses. Respiratory tract infection was the most common association, followed by urinary tract infection. There was moderate anemia with dimorphic picture (40%). Thirteen (52%) had vitamin B12 levels below normal. Magnesium levels, though statistically insignificant ( = 0.8) were lower in patients with tremors. This is a disease of multi-micronutrient deficiency, which can be present either alone or in association. Educating women about proper nutrition during pregnancy and timely administration of complementary feeding is of utmost importance.