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Nutrition in Pediatrics—Basic Science and Clinical Application
  1. S C LING,
  2. L T WEAVER

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Nutrition in Pediatrics—Basic Science and Clinical Application. 2nd edn. Edited by Walker WA, Watkins JB. (Pp 850; illustrated; price not given.) Hamilton: BC Decker Inc, 1996. ISBN 1-55009-026-7.

Readers of Gut might feel that paediatric nutrition is not among their main interests, but for those who seek to know what is happening in this closely allied field, through scientific curiosity or a desire to expand their clinical horizons, this book is a good starting point. Edited by two American paediatricians who have been energetic and influential in establishing paediatric gastroenterology as a distinct subspecialty, this book aims to do the same for paediatric nutrition. We believe that this book is of value both to trainees and those with an established interest in the field, and therefore we judge it from both viewpoints.

The novice will find that this book, divided into two halves, supports the editors’ view that paediatric nutrition has come of age: general concepts, nutritional physiology and pathophysiology are well covered in the first half; and perinatal nutrition, nutritional aspects of specific disease states, followed by nutritional support, in the second. The balance between theory and practice reflects the sound basic research that has led to the growing importance of clinical nutrition to child health.

When it is estimated that more than three quarters of the world’s children are undernourished, it is disappointing that the book is unashamedly directed at the developed world, with little on the aetiology, effects, recognition, and management of nutritional problems that occur in developing countries. Only half a paragraph is given to one of the most important advances in global child health in the past decade, the reduced mortality associated with reversal of mild vitamin A deficiency. The only reference to kwashiorkor is in the chapter on nutritional anaemias, and we could find little on protein-energy malnutrition in the developing world, even in the chapter devoted to malnutrition in hospitalised children. However, three chapters emphasise the importance of human milk and breast feeding to infant nutrition, and the amount of research that has gone into this field. It is encouraging to see the practical “Approach to breast-feeding” chapter included in a book otherwise largely concerned with science and disease.

The focus of textbooks has moved away from “nutrients” towards “nutritional support”, recognising the critical part malnutrition plays in chronic childhood diseases. In considering specific diseases, the book recognises that the efficacy of nutritional support is proved in some areas (for example, Crohn’s disease, short bowel syndrome, and renal failure), but avoids discussion of a more controversial and difficult topic, nutritional support in congenital heart disease. The final section includes chapters on parenteral and enteral nutrition.

For the specialist in paediatric nutrition this book compares well with its competitors, and in its second edition it is strong in clinical application. However, with its international authorship and presumed international readership it is a pity that there is not more on global problems in paediatric nutrition, which would broaden its appeal. Nevertheless, at a time when paediatric nutrition is close to standing alone as a distinct subspecialty, this book will find a secure place as a standard text for students, trainees, teachers, and practising paediatricians.

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