Chronic recurrent multifocal osteomyelitis (CRMO), first described in 1972, usually affects the long bones but it has affected the clavicle in about half of the 120 reported cases, and may be the paediatric equivalent of an adult syndrome given the name SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis). Affected children may also have pustulosis palmoplantaris. The clavicular disease has been variously called chronic sclerosing osteomyelitis, condensing osteomyelitis, sclerosis and hyperostosis, and pustolotic arthro-osteitis. Radiologically there is hyperostosis, osteosclerosis, and osteolysis. In Würzburg, Germany six of 11 children with CRMO had clavicular disease (European Journal of Pediatrics 1998;157:28–33). Plain radiography and radioisotope bone scan were the most helpful investigations; computed tomography and magnetic resonance imaging were misinterpreted as showing malignancy. Non-steroidal antiinflammatory drugs were symptomatically effective and the long term prognosis was good. The cause is unknown.

A study in Denmark (Acta Psychiatrica Scandinavica1997;96:402–4) illustrates well the near impossibility of drawing conclusions from non-randomised groups. There were 50 children of schizophrenic mothers, 25 of whom were brought up apart from their mothers and 25 with their mothers. Eighteen of the reared apart children and 13 of those who stayed with their mothers had developed psychiatric problems by their late …