Infantile and Pre infantile i Tremor syndrome is a peculiar condition most commonly seen in Indian subcontinent. Although the number of cases with this syndrome has reduced in recent years, finding of additional clinical features made us to present this series.30 cases (25 Pre-Infantile Tremor Syndrome and 5 Infantile Tremor Syndrome) were seen during September 2012 to September 2013.Mean age of presentation was 9.96 month. The male to female ratio is 1:1. Pigmentation and pallor is present in

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... ll cases while delayed development in (80%), and tremors in (13%) cases. Hepatomegaly was present in 16(53%) cases while splenomegaly in 6 (20%) cases. LRTI was presenting feature in 43% cases followed by AGE (20%) and malaria (16.6%).Striking features was malaria parasite in 4 (80%)out of 5 infantile tremor syndrome and dimorphic anemia in 13 (43%) cases, with Vitamin B12 level less than 200 in 80% cases. All children received Vitamin B12, antibiotics and folic acid. The mean duration of tremor phase was 10.2days with range 5 to 15 days. There was one mortality due to septic shock. Vitamin B12and folic acid plays significant therapeutic role in ITS management. Abstract: