Sir.—I wish to thank Drs Joseph and Rosenfeld1 for their evaluation of the frequency and presentation of clavicular fractures in newborns. This is useful information for "frontline" pediatricians like myself, but I would like to make the following comments.
The fact that the occurrence of newborn clavicular fractures has remained stable in the Western world during the past 85 years suggests to me that the New York State Health Department may be on the wrong track if it thinks that this is "an indicator of the quality of care."
Also, it seems that clavicular fractures are benign occurrences that virtually always heal well without intervention. The only reason then to diagnose clavicular fracture would be to explain irritability with motion or asymmetric Moro's reflexes. That suggests to me that, in children without these symptoms, there may be no reason to make a significant effort to make this diagnosis.