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Fast facts—infant nutrition
  1. L T Weaver

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    Alan Lucas, and Stanley Zlotkin. Oxford: Health Press, 2003. £12.00 paperback, pp 108. ISBN 1899541934

    The authors are well known for their research in infant nutrition and both have contributed to major textbooks on neonatology and the nutritional needs of preterm infants. I hoped therefore that this handbook might be the “indispensable guide to clinical practice” that it is billed to be on its front cover. As soon as the book reached me I skimmed through it, starting with the Introduction.

    Fast facts—infant nutrition provides practical, evidence based guidance to a broad range of health professionals involved in paediatrics”. Taking this statement as a starting point I decided to pose myself seven simple and basic questions that one might expect such a book to answer. How much milk does a newborn baby need? What is the energy requirement of a 6 month old baby? Does a 9 month old require vitamin supplements? When can whole cows’ milk be given? How much should a 3 month old baby weigh? What sort of solids should a baby start on? How long should mothers go on breast feeding?

    The answers to most of these questions were to be found, but with varying degrees of ease and difficulty. The closest I could get to how much milk a baby should take was a minimum volume of 600 ml, from 4 months onwards. Neither “energy” nor “calorie” appear as headings in the index, even though tables 2.3 and 2.4 and the associated text deal with their requirements. Under “multivitamins” attention is drawn to the differing recommendations in the UK (yes) and North America (no) for supplementation of vitamin A, C, and D after 6 months, without any evidence to explain each. However, on page 45 it is recommended, because it is not possible to identify all infants at risk of vitamin D deficiency, that supplements are prudent for breast fed full term infants. Cows’ milk appears in the index but table 3.3 is the only indication, not definitive, of when it might be given alone. There are growth charts in the chapter on growth, but only as examples. None is provided for both sexes, which can be used for reference. The answer to what sort of solids to start with can be found, via the index, in the chapter on transition to solid foods. However, the most useful table (3.3) is in the chapter on growth.

    Reading the book from cover to cover provides an overview of the physiology, nutritional requirements, growth, and modes of feeding of infants, and selected information on clinical and health issues. The emphasis is on healthy babies in the developed world, including preterm infants. The four fifths of children born in the developing world are largely neglected. The section on gastroenteritis properly recommends orally rehydration therapy, but there is nothing to be found on cereal based solutions or re-feeding after diarrhoea. Neither AIDS nor HIV appears in the index, even though they are mentioned as potential contraindications to breast feeding. How best to feed babies born of HIV positive mothers is a pressing problem for those who look after them.

    This book is not so much “fast facts” as “ready overview”. Although it will fit in the pocket, it won’t equip the busy SHO with what he or she needs to deal with the everyday problems of infant feeding and nutrition. It will however give them a useful starting point to learn more about this extremely important branch of paediatrics.

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