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Recent Advances in Paediatrics.
  1. MARTIN MONCRIEFF, Consultant paediatrician

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    Recent Advances in Paediatrics. 15th Ed. Edited by T J David. (Pp 246; £35.00 paperback.) Churchill Livingstone, 1997. ISBN 0-443-05849-0.

    The eagerly awaited 15th edition of Recent Advances in Paediatrics has just arrived. There is no disappointment. Professor David has maintained the high standard we have been led to expect. This is an excellent series which enables paediatricians to keep themselves up to date with medical progress in a relatively painless fashion. This book is well worth buying and reading carefully.

    The format is unchanged. There are a dozen chapters of general paediatric interest, and the comprehensive literature review by the editor. Each topic is clearly presented with helpful tables and numerous subheadings. Each finishes with a number of key points and numerous references.

    The subjects covered are wide ranging including bronchiolitis, large airways disease, thalassaemia, congenital hypothyroidism, and coeliac disease. There is a stimulating and partly speculative account of superantigen diseases. Two chapters are devoted to problems in the newborn, pulmonary hypertension, and breast feeding. A chapter on cholera, not usually a clinical problem in the UK, illustrates many of the health and social problems of the underdeveloped world. Spread may be rapid, the number of patients enormous, and the mortality appalling with 10 000 deaths in South America alone over three years. Good hygiene and clean water could prevent much of this, but governments lack the will to deal with poverty and the environment while population expansion and wars compound the problem.

    Recent Advances in Paediatrics usually includes a chapter on recent progress in a physiological topic and its clinical application, and this time is about nitric oxide. This is certainly a new topic which has only attracted study in the last few years, although apparently active biologically for ‘up to half a billion years’.

    A chapter on headaches guides us through the appropriate imaging, stressing how uncommon it is to find unexpected pathology with a normal clinical examination, but recognising the role of anxiety in generating investigations. The fact that headaches and a brain tumour are extremely rare, are nearly always associated with other signs and symptoms, and get progressively worse should help paediatricians to resist reaching for the imaging request forms, with careful follow up being more appropriate.

    The final chapter is on sleep problems. Before reading this my view was rather limited to children who don’t sleep and others who sleep too much, with occasional night terrors or seizures, and wondering when I will see my first case of narcolepsy. I’ve always been haunted by Professor Illingworth’s view which blames refusal to go to sleep on parental mismanagement and advises that the child be ‘left to cry’. I prefer William Cant’s advice that ‘The devil gets into them [babies] at an early age and of course you should have the baby in your bed’. As usual the best advice is probably somewhere in between the two extremes. This is an interesting chapter and should be read.

    Finally, the excellent literature review. The main interest of course is ‘am I quoted?’ For me with only an occasional publication, this is unlikely, but in this case I am, slightly obliquely. Can you spot it?