Pathology appearing in malnourished children between 5 months and 3 years age, especially described in India in infants whose mother is vegetarian and who are exclusively breast fed.

Association of:

-        palor, pudgy appearance

-        growth retardation, expressionless facies, hypotonia

-        skin hyperpigmentation over knuckle, elbows and knees

-        scanty hair

-        intermittent or continuous tremor of the limbs. Tremor tends to increase with cries and to disappear during sleep.

Biology: more or less important macrocytic anemia, insufficient blood levels of vitamin B12, other deficiencies in microelements (Mg, Zn, vitamin C)

Administration of vitamin B12 and multivitamin syrup has a dramatic effect in a few days.

In case of late diagnosis, permanent cognitive and speech disorders can persist.

Anesthetic implications:

anemia, vitamin B12 deficiency (nitrous oxide contraindicated)

References :

-        Apporva PS, Shubba STK, Rajakumar PS.
Infantile tremor syndrome.
Int J Contemp Pediatr 2017 ; 4 : 2228-30.

-        Sharawat IK, Kasinathan A, Sankhyan N.
Infantile tremor syndrome: response to B12 therapy.
J Pediatr 2018; 196:323

Updated: May 2018