Bacterial overgrowth and carbohydrate malabsorption, particularly of sucrose, should be considered when assessing children with CF and abnormal stool patterns.

A retrospective review was carried out of 11 consecutive patients with the Pierre Robin sequence referred to a tertiary paediatric referral centre over a five year period from 1993 to 1998. Ten patients were diagnosed with significant upper airway obstruction; seven of these presented late at between 24 and 51 days of age. Failure to thrive occured in six of these seven infants at the time of presentation, and was a strong indicator of the severity of upper airway obstruction. Growth normalised on treatment of the upper airway obstruction with nasopharyngeal tube placement. All children had been reviewed by either an experienced general paediatrician or a neonatologist in the first week of life, suggesting that clinical signs alone are insuYcent to alert the physician to the degree of upper airway obstruction or that obstruction developed gradually after discharge home. The use of polysomnography greatly improved the diagnostic accuracy in assesssing the severity of upper airway obstruction and monitoring the response to treatment. This report highlights the prevalence of late presentation of upper airway obstruction in the Pierre Robin sequence and emphasises the need for close prospective respiratory monitoring in this condition. Objective measures such as polysomnography should be used, as clinical signs alone may be an inadequate guide to the degree of upper airway obstruction. (Arch Dis Child 2000;83:435-438)

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SUMMARY A method of diagnosing gastrooesophageal reflux using ultrasound is described. This method was compared with barium swallow examination in 20 patients and found to be as accurate in infants and young children.Gastro-oesophageal reflux is an important cause of failure to thrive in infants and children. It may also lead to blood loss and repeated chest infections and is implicated as one of the factors in 'cot death'.' Barium swallow examination is the established method of diagnosing reflux in infants and children. In our department 64 barium examinations were carried out in 1982 for suspected gastro-oesophageal reflux. We describe a method of diagnosing this important condition using real time ultrasound equipment. Materials and methodTwenty infants and children from age 4 days to 16 years were studied by both barium and ultrasound techniques. The examinations were performed by two operators. The barium swallow was done first and was followed almost immediately by ultrasound, without the second operator knowing the result of the barium examination.For the barium examination, a standard technique was used combined with fluoroscopy and spot films. Ultrasound examinations were carried out with the patient in the supine position. A commercially available real time sector scanner (ATL 500) was used with 3.5 MHz in-line transducer with a 900 sector. The transducer was placed in the epigastrium below the xiphisternum to obtain a midline sagittal section going through the skin and subcutaneous tissues, left lobe of the liver, aorta, left hemidiaphragm, and the spine. It is important that the section contains several centimetres length of the long axis of the aorta and certainly 1 to 2 cm above and 2 cm below the diaphragm. The transducer is then moved to the right of the midline (approximately 2 cm) and the beam is angled slightly medially to ensure that the aorta remains in the section. In our experience, the cardia is outlined easily with this slight angulation of the beam. To ensure that the oesophagus empties completely the baby is held in the erect position or the child is made to sit up at least twice and is then scanned again in the supine position. The examination is observed on the screen and recorded intermittently on a video cassette recorder. Hard copy on photographic paper is obtained by a freeze frame facility but this leads to considerable degradation of the recorded detail of the dynamic nature of the reflux.Results

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