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In young infants the vertebral arteries may be compressed between the occiput and the first cervical vertebra on neck extension. Pathologists in Sydney, Australia (Pediatrics1999:103:460–8) examined the necks of 20 infants at necropsy. Nine had a diagnosis of sudden infant death syndrome and 11 had died of other causes. Five were examined with the neck extended; both SIDS infants and one of three non-SIDS showed bilateral vertebral compression. Nine were examined with the head rotated to the right; left vertebral artery compression was seen in two of four SIDS infants and one of five non-SIDS. No vertebral artery compression was seen when the head and neck were in the neutral position. What this means as regards the cause of SIDS is a matter for speculation but the authors make the obvious point that neck extension is associated with the prone position.
Is obsessive compulsive disorder (OCD) like attention deficit hyperactivity disorder in that it is diagnosed and treated much more readily in the USA than in the UK? It has been estimated that about one in 200 young Americans have OCD and about half of them start in childhood. A multicentre trial involving 187 children and adolescents (Journal of the American Medical Association 1998;280:1752–6) …