Book Review

From Heredity to Anatomy

Epidemiology of Childhood Disorders

N Engl J Med 1994; 331:886September 29, 1994

Article

Epidemiology of Childhood Disorders
Edited by Ivan Barry Pless. 531 pp. New York, Oxford University Press, 1994. $75. ISBN: 0-19-507516-1

With the help of 23 experts the editor has produced an excellent book on pediatric epidemiology for a wide readership, from novice to expert. It is the first attempt to squeeze scattered information on pediatric epidemiology into a single book. In fact, each of the 18 topics covered would easily merit a monograph.

The book begins with two chapters on the basic terms, concepts, and methods used in epidemiology and a critical view of the longitudinal cohort study as a tool in pediatric epidemiology. Although brief, these two lucid chapters are particularly valuable for students or novices. The five sections that follow cover diverse pediatric disorders. Individual sections contain two to four independent chapters. In the first section, on perinatal disorders, the first chapter provides basic information on low birth weight and prematurity. Birth weight is the chief determinant of neonatal morbidity and mortality, which, in turn, is the principal determinant of infant mortality. This chapter could have been expanded with more references. The next two chapters, on structural birth defects and genetic disorders, are excellent, concise treatises.

The four chapters in the second section, on infectious disorders, are clearly written and informative. The last chapter, which deals with five common contagious diseases of childhood, is a gem: well organized, current, to the point, and listing suggested readings.

The third section starts with a chapter on mental retardation, which lists multiple heterogeneous groups of disorders but fails to convey the proportional importance of these entities in causing mental retardation. For example, hyperbilirubinemia, isoimmunization, and single umbilical artery are mentioned, but not cerebral intraventricular hemorrhage. The next chapter, on emotional and behavioral problems, dwells mainly on difficulties in the classification, identification, and comparability of prevalence of these disorders over time. The chapter on suicide is a precise, well-organized, and informative review of the literature.

The fourth section covers injuries and violence. Over the past several decades, the prevalence of infectious diseases has fallen remarkably; at the same time, injury has emerged as a major preventable cause of morbidity and mortality among children. These chapters are timely and well presented, with up-to-date references, but the discussion of child abuse and neglect could have been more detailed.

The fifth and final section presents chronic disorders such as asthma, malignant diseases, and cerebral palsy. The last chapter focuses on the prediction of adult disease. It describes how to conduct an epidemiologic search for associations between health in early life and adult health by illustrating such associations in cardiovascular disease and lower respiratory tract illness. It provides a critical review of epidemiologic techniques and future directions for research in this field.

In conclusion, this book discusses diverse topics related to childhood disorders in chapters that have a common thread: critical reviews of epidemiologic investigations of individual disorders. It contains broad-based but not overly detailed information and provides ample references for future reading. This book will not only be a timely addition to the libraries of readers interested in epidemiology but will also serve well as a general textbook for classes in maternal and child health.

Kwang-Sun Lee, M.D.
University of Chicago, Chicago, IL 60637