The child's voice changes so that the cry gets more and more hoarse until no sound at all is produced. Strikingly, these children do appear to be crying without any noise. Without treatment they progress over a few days to restlessness, oedema, breathlessness and then death. This usually occurs in 6-12 month old and is the equivalent of Wernickie's encephalopathy in the infant. There is nystagmus, muscle twitching, a bulging fontanelle, convulsions and unconsciousness.
Older children get the same features as adults.
What to do when beri-beri is suspected . Give 50 or 100 mg thiamine hydrochloride intravenously and then give 10 mg per day orally. Mothers of patients should always be given 10mg per day orally. The response is rapid in wet and infantile beri-beri. It is dramatic with visible resolution of much of the oedema over 4 to 8 hours followed by complete loss over the next 48 hours.