Reviewing earlier diagnoses of chromosome.

How many inpatient paediatric units do we need? EDITOR,-In his article on paediatric inpa-tient units, Professor Taylor claims that many present paediatric units are too small to provide safe and cost effective care, do not meet required standards, and should combine into larger units providing specialist children's services.' We would disagree with him, at least with regard to rural communities. In many small district general hospitals a very high standard of care is offered, frequently directly by the consultant and often at great personal cost. The service shares many of the better aspects of primary care delivered by staff who know the families and their backgrounds. Professor Taylor stresses the value of a good relationship with the tertiary centres; where this exists children can be referred to superspecialists when indicated. He does, however, make a good case for continuing update and education for all staff and the need for clinical commitments to be such that study and development of appropriate skills are possible. In a country area almost all acute admissions are at the request of a general practitioner. The request to admit is not undertaken without thought, although the reason is rarely that the disease is life threatening ; parental anxiety, inexperience, exhaustion , lack of transport or telephone, or even inability to carry out instructions may all be factors. Is it feasible that a visiting service could overcome these difficulties? If rural units were to be amalgamated for financial reasons, children in Cumbria, for example, could have to travel 40 miles for in-patient care even if lucky enough to be left with a day centre. As most acute admissions occur in the evening and at weekends, few could be observed locally, even for a few hours. A massive increase in funding of the ambulance service, roads, and public transport would be needed. Sick children would need to travel for an hour before assessment by a paediatrician and family disruption would be extreme. It would be a brave obstetrician who considered offering a service where unforeseen complications in even 'low risk' deliveries were the responsibility of obstetric staff or even nurse practitioners, if the nearest paediatric support was 40 miles away. Professor Taylor's sad experience of district general hospital care for children is not universal. Even in today's climate of rising expectations and workload, some units are proud to provide a local and appropriate service. The equation should be …