There have been about 20 studies of analgesia for neonatal circumcision over the last two decades. Now a study in Canada (New England Journal of Medicine1997;336:1197-201) has shown a 2.5% lidocaine, 2.5% prilocaine cream (Emla cream) to be effective. In 59 babies randomised to this cream or placebo the analgesic cream was associated with up to 50% less facial activity at various points in the procedure and a significant reduction in time spent crying. There were no observed adverse effects and in particular the cream did not give rise to methaemoglobinaemia. Nevertheless Lucina just wonders how many adults would volunteer for circumcision under Emla cream analgesia.

Some 98% of all deaths in childhood occur in developing countries with pneumonia, diarrhoea, perinatal disorders, and measles being the chief causes (Lancet 1997;349:1269-76). The probability of dying in childhood is about 1% in industrialised countries and 22% in the developing world. In sub-Saharan Africa over half of all deaths are of children under 5.

Professor Heinz Prechtl and his collaborators classify the generalised movements of normal babies as writhing movements in the first 6 weeks, changing between 6 and 9 weeks to fidgety movements …