Infantile tremor syndrome (ITS) is a self-limiting clinical condition primarily affecting infants. It is characterised by a constellation of symptoms, including coarse tremors, often exacerbated by wakefulness and mitigated during sleep, anaemia, distinctive skin pigmentation changes, developmental regression and hypotonia in seemingly well-nourished infants. While a definitive aetiology remains elusive, various hypotheses have been proposed, including infectious, metabolic and nutritional factors. A growing body of evidence implicates Vitamin B12 deficiency as a significant contributor to ITS pathogenesis, though this association remains a subject of ongoing debate. In the absence of a conclusive diagnosis, empirical management often involves a multifaceted approach. Nutritional supplementation with iron, calcium, magnesium, Vitamin B12 and other essential micronutrients is a cornerstone of treatment. Pharmacotherapy, primarily with propranolol, may be employed to alleviate tremors, though other anticonvulsants such as phenobarbital, phenytoin and carbamazepine may be considered in refractory cases.
Singhal et al. (2026) studied this question.