To the Editor: While we enjoyed reading Sewell's article summarising advances in paediatrics, there was no mention of developments in general paediatric surgery.1 About a third of all patients admitted to a paediatric hospital have surgical conditions. Viable advances would thus have significant implications for many children and their families.

Prevention: Although vaccination against infectious diseases remains vital, the greatest killer of children in Australia is trauma.2 Detailed analysis of patterns of injury morbidity and mortality enable recommendations for prevention to be made. Legislation to reduce the risk of scalding was enacted in 1999 in NSW to regulate the temperature of hot water in new homes. Similar measures, in addition to educating families and their local doctors, have been proposed to prevent driveway and horse-related trauma in children.3,4 Overseas data confirm that such interventions may be effective in helping to reduce Australia's present mortality rate from injury of 9.5 per 100 000 children in 1991–1995 to Sweden's rate of 5.2 per 100 000.5

Diagnosis: Laser Doppler imaging of paediatric burns will enable the surgeon to determine the requirement for operative intervention within 48 hours of the burn, expediting treatment and reducing costs.6 In conjunction with the use of cultured keratinocytes, the risk of subsequent scarring should be minimised.7

Antenatal diagnosis of hydronephrosis and hydroureter has assisted in our understanding of the natural history of urological disease in childhood, helping refine the indications for surgical intervention.8

Intervention: The safety of early surgical intervention in childhood is now well established. Many common conditions such as hypospadias are now optimally treated before the child's first birthday, requiring earlier referral.9

Minimally invasive surgery has now evolved into a useful additional technique in children, in conjunction with the development of appropriate indications, suitable instruments and specialist surgical skills.10

While brevity may be an editorial necessity, paediatric surgery encompasses many areas. Although our selection represents a personal choice, advances require active involvement and consultation with colleagues across all specialties.