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To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL).A total of 215 patients were divided into three groups: 135 (5-14 years of age) with paediatric constipation (PC), 56 (5-17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5-16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG).No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles.There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.

Editor,—The letters from Drs Deshpande and Nicholl, in relation to the Impact-RSV study and the UK guidance for the use of palivizumab in the prevention of serious RSV infections, raise interesting questions that need to be addressed. I believe Dr Deshpande “has got it wrong” in that he fails to realise that the primary objective of the IMpact study was to investigate whether palivizumab reduced RSV hospitalisations in high risk infants. It was never intended that this study would address the severity of RSV infections, the need for paediatric intensive care, the need for mechanical ventilation, or a reduction in death rate. It is unreasonable to suggest that because the study didn't show these then it is not valid. To show such benefits would require a totally different protocol, the numbers of patients being such that the study could never have been undertaken. To reiterate the findings of the IMpact study, there was a 55% reduction in hospital admission rate for RSV proven disease—a significant result, however one wishes to interpret it. Those high risk patients admitted with RSV infection spent fewer days in hospital, had less need for oxygen treatment, and had lower respiratory infection clinical scores if they received palivizumab. The study was designed in association with and with the approval of the licensing authorities to grant a marketing licence for the medication. It was not designed to provide economic data on the cost effectiveness of the product. Both Deshpande and Nicholl fail to realise that if they want this information then different studies are needed. Does anyone know the lifelong cost of RSV disease in infancy? What is the relationship between RSV hospitalisation in the first year of life, recurrent wheezing in childhood, or indeed the possible development of chronic obstructive pulmonary …