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Since 1985, measurement of the length of neonates has been practically abandoned in the Netherlands because it was thought that stretching the legs and knees briefly in order to measure the length immediately after birth could be harmful for the development of the hip joint. However, this fear seems unjustified. Measuring the length of the neonate provides useful information regarding the general condition and has predictive value for the final adult height. If an infant is disproportionately small in comparison with its weight or small for its gestational age with insufficient catch-up growth, this may be an indication of underlying pathology. As a rule, the length of all neonates should be measured immediately after birth and length measurement should be re-introduced as part of standard care. Length measurement can be done with sufficient accuracy after proper instruction. For babies born after incomplete breech presentation, length measurement should be postponed for about a week.

A girl with Turner's syndrome due to a 45,X mosaicism and a ring chromosome was born to a 29-year-old mother with a non-mosaic 45,X in her blood lymphocytes. Cytogenetic investigation revealed that the ring chromosome of the daughter included almost the entire X chromosome with the exception of the uppermost part of the short arm. In the literature, girls with Turner's syndrome are said to have functional ovarian tissue and pregnancies in women with Turner's syndrome after oocyte donation and intracytoplasmatic sperm injection (ICSI) are no longer exceptional. However, since ovarian failure occurs relatively early during adolescence, cryopreservation of ovarian tissue should be considered as soon as the girl or her parents are able to make the necessary decisions. On the other hand, beside risks for congenital anomalies in the newborn, the risks of pregnancies in Turner's syndrome should not be neglected, notably premature delivery due to disproportion between the pelvis and the foetus and aortic dissection in the pregnant woman.

Objective: To determine the age at which children gain bladder control and to compare this with the data from 30 years ago., Design: Questionnaires., Method: On the basis of the findings of a 1966 study into toilet training in the Eindhoven and de Kempen region, the Netherlands, a questionnaire was drawn up and distributed via 30 child-health clinics in this region to parents of children aged 12-59 months, during the period 1 March-30 June 1996. The results were compared with those of the earlier study., Results: Data from 1176 children could be evaluated (response rate: 65%). In 1996, the median age for bladder control in boys during the day was 32.6 months and 40.5 months for night-time control. In 1996 boys achieved daytime bladder control 6.7 months earlier and night-time control 7.2 months earlier. In 1996, the median age for girls was 29.7 months for daytime control and 35.4 months for night-time bladder control: in 1966 girls achieved daytime and night-time bladder control 8.2 and 4.8 months earlier, respectively. Factors associated with earlier bladder control were: early age at which parents started toilet training, presence of other children in the family, early age at which the child attended a day-care centre, early age at which the child was able to walk. Other factors such as the presence of a complete family set, parental level of education and professional situation did not show a correlation with the age at which the child achieved bladder control. The type of diaper used was an additional factor for bladder control at all ages but was only statistically significant for 3-year-olds, both during the day and during the night., Conclusion: Children in the Eindhoven region achieved daytime and night-time bladder control at a significantly later age than 30 years ago. Various factors such as toilet-training age, day-care attendance, family size and type of diaper played a role in this phenomenon.

Three mentally retarded male patients, 24, 30 and 14 years old, died from acute gastric dilatation leading to rupture and perforation. Superior mesenteric artery syndrome (SMA) was the cause of gastric dilatation in two of them. In the third patient the cause was not clear. The three patients had scoliosis and were underweight or thin. Two had spastic quadriplegia of perinatal origin and one had Down's syndrome. One patient with SMA was treated by Nissen fundoplication because of hiatus hernia with vomiting and gastro-oesophageal reflux one week before he died. Another patient had a severe gastric bleeding after decompression of the dilatation. In mentally retarded patients there are often several predisposing factors for SMA (anorexia, severe weight loss in a short time, pronounced lumbar lordosis, scoliosis, correction of scoliosis by operation or plaster cast, prolonged lying position, boulimia). Gastric dilatation may be prevented by ensuring adequate nutritional status.

Vitamin B12 deficiency is an uncommon disorder in a prosperous western country. In two children a nutritional vitamin B12 deficiency was observed. The first was a 2-year-old girl with neurodevelopmental regression and macrocytic anaemia, a result of a combination of a maternal vitamin B12 deficiency and inadequate feeding after birth. The second patient was a 14-year-old adipose girl with severe polyneuropathy and mild macrocytic anaemia as a result of a nutritional vitamin B12 deficiency. In her case the deficiency resulted from a bizarre feeding pattern. She turned out to be the victim of child abuse. It is concluded that even in a prosperous western country like the Netherlands vitamin B12 deficiency in children can develop as a result of an inadequate feeding pattern. It can lead not only to macrocytic anaemia but also to severe neurological abnormalities.

The high frequency of neonatal hypoglycaemia found in the St. Catherine's Hospital, Eindhoven [corrected], (8.2% of all newborn infants had values of 1.8 mmol/l glucose or less) promoted us to test the effects of the different conditions of blood preservation before measuring in a consecutive series of 18 newborn infants at risk for hypoglycaemia. When blood was preserved in microtest tubes coated with sodium fluoride (NaF) and measured after 1 hour at room temperature, the glucose level decreased by 7 to 36%. Storage on melting ice for one hour prevented this decline completely. In our hospital sodium fluoride coated microtest tubes are used. They were found to contain various concentrations of NaF, ranging from 0.85 to 2.65 mg/ml. In a 2nd experiment with cord blood from 8 patients, we proved that a concentration of 16 mg/ml sodium fluoride was necessary to inhibit glycolysis and to prevent a fall of plasma glucose. The rapid determination of blood glucose values, i.e. within 10 minutes after the blood sample is taken, decreased, as expected, the frequency of hypoglycaemia in the newborn at risk.

The case is described of an eleven-year-old boy with abdominal pain and hematuria. The hematuria appears to be fabricated by the father of the boy by adding cooked meat to the urine samples. The medical history of the father is very suspect for the Münchhausen syndrome. The case of the son differs in some respects from the normal pattern of the Münchhausen by proxy syndrome: the age of the son, the role of the father as active inducer and the low social class of the family.

In a prospective study CRP and BSE values were compared in 130 children who came to the first aid of our hospital with symptoms suspicious for an infection either viral or bacterial. Since the predictive value of both parameters dependents on the prevalence of diseases we discussed the likelihood ratio and the receiver operating characteristic as better parameters in the evaluation of a test i.e. BSE and CRP. It finally became clear that such characteristics are useful in clinical practice and therefore deserve more attention.

In the region Eindhoven 36 children with Campylobacter-enteritis were examined from I January 1980 to 31 December 1980. Symptoms were studied and stools were cultured over a four-month period. Abdominal pain and/or diarrhea occurred in more than 90% of patients and were not infrequently of longer duration. Bloody stools were found in 58% of patients and disappeared relatively early during the time of illness, as well as fever and vomiting. After one month Campylobacter could only be cultured in 5% of children; 14 household contacts, who proved to have Campylobacter-enteritis, had also negative stool cultures after one month. Asymptomatic carriership was found in four cases among these household contracts. Campylobacter fetus subspecies jejuni could not be isolated in stools of a number of asymptomatic individuals, working in the meat industry, who were considered to have a higher risk of infection. This group could therefore not be determined as an endogenous human reservoir. On the other hand Campylobacter was isolated in a few domestic animals without symptoms of illness, as well as in some cattle stables and sites. In these places, where several contaminated animals are together, significant reservoirs for human infection may be present.

Three newborn children with an osteomyelitis of the calcaneus as complication of a heel puncture are presented. A description of the technique of these punctures is given and the precautions are reminded.