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| Testimonials For Pediatric Oncall |
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Preeti
I am a final yr medical student and i just love ur website!!! I regularly use it to help me with my preparations. The topics are so lucidly written and easily understood with up to date information.. Even the HIV related web site ( www.hivinchildren.org) by Dr.Ira Shah is just fabulous!!! |
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Dr Parang N Mehta
Dear Dr Ira Shah, Congratulations on putting up an excellent website, which will be of great use to practicing pediatricians everywhere. You have achieved the near impossible in getting some of the biggest names in pediatrics in India to contribute content to your site. |
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| Sailala
An excellent website!! good and useful information! Many Thanks for to u all! |
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Sujatha
Very informative site, and queries are getting resolved immediately. Thanks |
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Uttam Laisram
I found the Vaccine Reminder feature on your Website very interesting. My request is that this useful facility may not be restricted to Registered Users, but may be made available to all Visitors, who may like to enter their child's details and take a print-out of the Vaccine schedule. Please consider. Keep up the excellent work in providing India-relevant information for child care. |
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| Infantile Tremor Syndrome |
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Dr Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS
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Infantile tremor syndrome (ITS) is a clinical disorder characterized by coarse tremors, anemia and regression of motor and mental milestones in children around 1 Year of age. It has been primarily reported from India and south East Asia.
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Etiology- Vitamin B12 deficiency has been found to be associated with ITS. However iron deficiency, magnesium deficiency and zinc deficiency have also been postulated. It is seen in children who are on prolonged exclusive breast-feeding with mothers who are predominantly vegetarians.
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Clinical Features- A classical picture of ITS is a plump looking infant between 6 months to 18 months with presence of malnutrition. These children are listless, apathetic and disinterested in surroundings. Scalp hair is sparse and light colored. Dark pigmentation is present over dorsal aspects of hands, nail folds, feet, knees, ankles, buttocks and axillae.
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There is regression of milestones in the recent past. Tremors have an acute onset following an acute infection or stress. Initially they are intermittent but become continuous in a few days. They are more prominent in distal parts of limbs, head, face and tongue. These tremors disappear during sleep.
Hypotonia with flabbiness of muscles is common. There is presence of anemia, which may be macrocytic, microcytic or even normocytic.
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Diagnosis - It is essentially a clinical diagnosis with peripheral smear suggestive of anemia. Vitamin B12 levels may be low. Vitamin B12 levels in the mother may also be low suggesting low levels in the breast milk.
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Treatment
Treatment consists of therapy for anemia and nutritional deficiency. Vitamin B12 in high doses may be required if B12 levels are low. Zinc and magnesium supplements may also be necessary. If the tremors are severe, phenobarbitone (3-5 mg/kg/day) may be required to decrease the intensity. The tremors subside slowly. Initially there is gradual reduction in the amplitude and severity then the tremors become intermittent and finally stop. Pigmentary changes in skin and hair take months to clear. Mental dullness and sluggishness takes years to come back to normal.
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References
- Gupte S: Infantile tremor syndrome. In The Short Textbook of Pediatrics, 8th edn, New Delhi: Jaypee Brothers 1998; 558-61.
Last Updated on 11-08-2007
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