Neonatal death--the neglected side of neonatal care?

Professor and Dr Illingworth comment: We thank Dr Shield for his comment on our paper1 concerning the section on 'normal' toe walking. Editors of journals have an annoying, yet justified way of demanding brevity, and brevity has its dangers. We are aware of the possible causes of toe walking and one of us has listed the following:4 normal toe walking in the preterm baby who has reached 'term' (not strictly toe walking except in the walking reflex), the normal, common toe walking of toddlers, spastic cerebral palsy, congenital shortening of the Achilles tendon, dystonia musculorum deformans, autism, Duchenne muscular dystrophy, peroneal muscular atrophy, spinal cord tumour, and shortening or apparent shortening of a leg (for example unilateral congenital dislocation of a hip). The difficulty we all have is that of deciding at what stage we should investigate. We would not agree that every toe walker without obvious physical signs should have a CPU or other investigation. It would certainly be sensible to investigate a toe walker who had no abnormal signs but was late in developmental milestones as are many or most children with Duchenne muscular dystrophy.