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W Allan Walker, John B Watkins, and Christopher Duggan. Ontario: BC Decker Inc., 2003. $198.00, hardback, pp 1075. ISBN 1 55009 226 X.
In large Victorian households, feeding the children in the nursery was traditionally left to the youngest and most inexperienced housemaid. Recognition of the importance of nutrition in children in hospital and in the community has been equally slow. Medical undergraduates continue to receive little teaching on nutrition, even though over- and under-nutrition continue to be seemingly intractable problems; a substantial proportion, maybe a third, of patients in children’s hospitals exhibit evidence of malnutrition. Moreover, we are now recognising that fetal and infant nutrition are major determinants of long term health.
One reason for the glacial speed in the development of clinical nutrition has been a view that clinicians already know enough about nutrition. That view is fostered in part by nutritional knowledge being recorded in the literature in disparate sites and in different ways. Much of it is in textbooks of biochemistry and metabolism; only rarely is it easily accessible. There is no obvious course book for the Royal College of Paediatrics and Children Health Diploma Course in Nutrition (www.rcpch.ac.uk).
Having the relevant basic science pulled together in one volume is immensely helpful to specialty developments; failure to do so is enormously damaging. One of the most interesting and exciting innovations in paediatric practice in the past 50 years in the United Kingdom was the concept of community paediatrics. It has foundered, partly because the basic science underpinning the discipline was never collected, written down, and published. Clinical texts are little more than recipe books without the underpinning basic science.
Nutrition in pediatrics addresses many of these problems, and the editors are to be congratulated on a tour de force. My assumption about its scope being limited to hospital based, clinical nutrition has not been confirmed. It is useful to the paediatrician working in the community or in developing countries as well as the tertiary, hospital based specialist. The psychosocial aspects of feeding are well covered and I was pleased to see sections devoted specifically to adolescents. There are no obvious gaps.
The RCPCH is seeking to redress the lack of teaching in nutrition in undergraduate medical courses with its course in paediatric nutrition. This volume makes an ideal course book, and should also be a routine acquisition for all postgraduate and ward libraries. Buy.