The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

Book Reviews

IN

HEADACHE AND MIGRAINE CHILDHOOD AND ADOLESCENCE

Edited by Vincenzo Guidetti, George Russell, Matti Sillanpaa, and Paul Winner. 304 pp., illustrated. London, Martin Dunitz, 2001. $125. ISBN 1-85317-810-1.

EADACHES and migraines occur in a large proportion of children. Up to 10 percent of 5-to-15-year-olds have been reported to have migraines, and up to 28 percent of girls between the ages of 15 and 19 appear to have migraines. In addition, by the age of 5, 25 percent of children have had a notable headache, a proportion that increases to 75 percent by the age of 15. Given the common occurrence of these disorders, it is surprising how few detailed, complete books exist on the subject. Headache and Migraine in Childhood and Adolescence helps to fill this gap by providing indepth information on childhood headache disorders. Headache experts from 10 different countries are represented, with a substantial contribution from Italian workers in the field. The wide variety of topics includes the basic pathophysiology of childhood migraines and headache disorders and a description of assessment and diagnosis. A thorough discussion of childhood migraines makes up a large portion of the book, but space is also devoted to cluster headaches, tension-type headaches, chronic daily headaches, and so-called psychogenic headaches. There is also a discussion of secondary, or symptomatic, headaches. Treatment is discussed in specific chapters dispersed throughout the book; this scheme helps when a question on the treatment of a particular childhood headache arises. A special section covers biofeedback and relaxation treatments, highlighting the multidisciplinary, broad-based approach that may be necessary for the management of headache disorders in children. In addition to a thorough discussion of evaluation and management, the book has practical advice for headache specialists and for general practitioners. The section on pathophysiology, though brief, is a broadbased review of the hypotheses underlying the pathophysiology of migraines. The chapters on neurochemistry and pharmacology complement each other quite well. The neurochemistry chapter outlines a broad variety of pathophysiologic considerations and discusses both the serotoninergic and the dopaminergic hypotheses. The complementary chapter on pharmacology discusses how treatments including triptans for the serotoninergic model and dopamine antagonists for the dopaminergic model can match the underlying pathophysiological processes. A brief but thorough discussion of a variety of prophylactic agents is also included. The section on assessment and diagnosis will meet the needs of both primary care physicians and headache experts. Its topics range from the basic assessment of childhood headache disorders to the roles of neuroimaging and neuropsychological assessment. In these areas, research is lacking, and a consensus statement about the appropriate use of these diagnostic tools is not possible; however, these sections of

the book are very helpful in the interpretation of current opinion and hypotheses. The section on migraine headaches, which are the most frequent form of episodic headaches in children, makes up a large part of the book. In stepwise fashion, it covers diagnosis, pathophysiology, clinical presentation, variations in presentation, outcome, and management. Although the authors cover this topic well, they are limited by the deficiency of scientific data on childhood migraines. They overcome this limitation by providing personal expert opinions and by discussing experience gained from practice, complementing their coverage of the available studies. In a unique section called Special Issues, a series of chapters goes beyond the typical discussion of headaches and migraines and considers why childrens headaches may differ from those in adults and how they may provide clues for understanding adult headache disorders. It discusses the relation between sleep and headaches and raises the question of cause and effect with respect to recurrent headaches and sleep disturbances. This section also includes several chapters on the sociopsychological effects of migraines on children on their pain perception and their quality of life, including the impact on their family and schoolwork. Overall, Headache and Migraine in Childhood and Adolescence successfully joins the small library of books available on childhood headache disorders. Its breadth and depth of coverage will make it a useful tool for all practitioners who see children and adolescents. It will also be a useful reference for headache specialists and a foundation on which to build further studies. ANDREW D. HERSHEY, M.D., PH.D.
Cincinnati Childrens Headache Center Cincinnati, OH 45229 andrew.hershey@chmcc.org

NUTRITION IN THE INFANT: PROBLEMS AND PRACTICAL PROCEDURES

Edited by Victor R. Preedy, George Grimble, and Ronald Watson. 464 pp., illustrated. London, Greenwich Medical Media, 2001. $129. ISBN 1-90015-162-6.

HIS new textbook focuses on providing a precise and practical framework for the evaluation and treatment of abnormal nutritional states in infants in industrialized countries. Many traditional textbooks deal with abnormal nutritional states mainly from a Third World perspective, so the three editors of Nutrition in the Infant two from the United Kingdom and one from the United States offer a complementary approach. To accomplish their aim, the editors have assembled an international team of 61 authors representing 14 countries and 5 continents, including a number who are acknowledged experts in the field. Although the authorship is global, the book consistently focuses on problems and issues facing health care professionals in industrialized countries. The book covers a comprehensive and balanced set of gen-

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BOOK REVIEWS

eral categories related to infant nutrition, including malnutrition, assessment of nutritional states, parenteral and enteral nutrition, micronutrient and macronutrient requirements, nutritional issues related to children with a variety of special needs, and developmental and educational perspectives. The quality and style of writing vary, as might be expected in a multiauthored book, but the contributions have been edited in a fairly crisp style, and the book is easy to read overall. The format also varies a bit from chapter to chapter, but the central feature in each chapter is a section called Practice and Procedures, which describes a concise, practical clinical approach to the particular topic. Although the title of the book is Nutrition in the Infant, a more accurate title might be Nutrition in the Infant and Child, since many of the chapters review topics that are more relevant to children than to infants. These chapters include discussion of dietary fiber, the use of low-fat diets, and nutrition in children with conditions such as intestinal transplants, diabetes mellitus, and Crohns disease. There is also a brief section on the diagnosis and management of childhood obesity. The chapters generally provide up-to-date reviews of important topics and uniformly place primary emphasis on practical elements of the current practice and procedures in industrialized countries. The references for most chapters offer some historical perspective as well as including a limited list of important recent citations and pertinent reviews, but some chapters contain much more encyclopedic lists. There are numerous tables and figures that are used well to enhance the narratives, but photographs are used only rarely. Despite the attempt at comprehensiveness, several topics are conspicuously absent. No chapter covers the theories and practice of feeding the premature infant, which is an important problem in industrialized countries. The rationale and recommendations for advancing the diet during the first year of life are not covered, and no chapter is devoted to the potential problems of weaning a major issue in both the industrialized and developing worlds. In future revisions of this textbook, the editors may also wish to consider including a section on the effects of abnormal nutrition in the infant, especially the effect on intellectual development. In addition, some coverage of the special issues related to abnormal nutrition in children in developing countries might provide a broader perspective from which to view the problems of infants in industrialized countries. Although one chapter deals with the promotion of breast-feeding, none presents a practical approach to successful nursing and methods of overcoming commonly encountered problems. Perhaps because of space constraints and attendant cost constraints, the editors did not include sections of graphics illustrating anthropometric measurements or tables of the nutrient composition of formulas for preterm infants or the nutrient requirements of term and preterm infants. An alternative to adding such sections would be the inclusion of an appendix with a list of Web sites that supply this information. Overall, the editors have succeeded in putting together a precise and practical textbook on infant and childhood nutrition. The book will be a useful resource for medical and

nursing students, residents, dietitians, and health care practitioners who deal with young children. JOHN SNYDER, M.D.
University of California, San Francisco San Francisco, CA 94143 jsnyder@peds.ucsf.edu

ACUTE

AND

PROCEDURE PAIN AND CHILDREN

IN

INFANTS

(Progress in Pain Research and Management. Vol. 20.) Edited by G. Allen Finley and Patrick J. McGrath. 183 pp., illustrated. Seattle, International Association for the Study of Pain, 2001. $70. ISBN 0-931092-39-6.

HIS book is based on presentations at the third biennial International Forum on Pediatric Pain, held at White Point Beach, Nova Scotia, Canada, in September 2000. It covers topics ranging from hyperalgesia and allodynia models in rat pups to pain management in infants, children, and adolescents. It also includes a discussion of the politics of pediatric pain and how we might achieve the goal of a pain-free hospital. As noted by the contributors, this book is not meant to be a guide for pain relief in pediatrics. The technical skills required to administer many of the analgesic and anaesthetic interventions discussed in this book have to be taught in the clinical setting by someone who is not only technically proficient but also sensitive to the special needs of children and their families. The authors provide good examples of how the best available evidence from basic science, from randomized, controlled clinical trials, and from other high-quality studies can be applied to individual patients. Physicians who can apply this evidence in a clinical setting and who have insight into and empathy for the special needs of sick children are likely not just to reduce pain but also to increase satisfaction with care, even if pain cannot be totally avoided. As I read this book, I noted considerable overlap among the chapters. Reference is often made to the same publications, but individual authors interpret the information differently. This applies particularly to the literature on how painful experiences during the neonatal period affect shortterm and long-term responses to pain. It appears to me that most authors think that there is a clear association between early painful stimuli and an exaggerated response or adverse outcome later in life. One author, however, concludes that the degree to which these experiences are detrimental is unknown. I side with the latter opinion and advocate rigorously planned, randomized, controlled trials that include the evaluation of long-term neurodevelopmental outcomes as part of their design. Although we are now aware that fetuses and preterm and term infants have the anatomical, physiologic, and biochemical systems necessary to respond to painful stimuli, our ability to measure acute and chronic pain and to provide adequate pain relief in this population remains limited.

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The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

I strongly recommend this book to researchers and physicians in the fields of perinatal, neonatal, pediatric, and adolescent medicine. This recommendation is based not only on the specific facts provided on the different approaches to pain relief, but also on the authors constructive attitude toward pain management in these age groups. It is our obligation to listen to and involve patients who have undergone neonatal intensive care or pediatric care and their families in an attempt to improve outcomes and satisfaction with care and to set the agenda for future research. ARNE OHLSSON, M.D.
University of Toronto Toronto, ON M5G 1X5, Canada aohlsson@mtsinai.on.ca
Book Reviews Copyright 2002 Massachusetts Medical Society.

I M E D EX

The following conferences will be held in New York, unless otherwise indicated: The 9th International Conference on Lyme Borreliosis and Other Tick-Borne Diseases (Aug. 1821); Small Cell Lung Cancer (Lausanne, Switzerland, Sept. 57); The 3rd Annual Perspectives in Colorectal Cancer (Chicago, Sept. 19 and 20); The Second Princess Margaret Hospital Conference: New Developments in Cancer Management (Toronto, Sept. 1921); The 7th International Conference on Geriatric Oncology: Cancer in the Elderly: SIOG (Boston, Sept. 27 and 28); Myeloma/Lymphoma (Oct. 35); Perspectives in Thoracic Cancer (Oct. 4 and 5); Perspectives in Breast Cancer (Atlanta, Oct. 17 and 18); The 9th Conference on Cancer Therapy with Antibodies and Immunoconjugates (Princeton, N.J., Oct. 2426); International Society for Human and Animal Mycosis 2003 (ISHAM) (San Antonio, Tex., May 2431, 2003); and MASCC 03: Supportive Care in Cancer (Berlin, Germany, June 1921, 2003). Contact Heather Drew, Imedex, 70 Technology Dr., Alpharetta, GA 30005; or call (770) 751-7332; or fax (770) 751-7334; or e-mail h.drew@imedex.com; or see http://www.imedex.com.

P R AC T I C A L A N ATO M Y WO R KS H O P, SA I N T L O U I S U N I V E R S I T Y

N OTICES
Notices submitted for publication should contain a mailing address and phone number of a contact person or department. We regret we are unable to publish all notices received. Notices also appear on the Journals Web site (http://www.nejm.org). The listings can be viewed in their entirety or searched by location, month, or key word.

P U B L I C L A B O R ATO RY L O I N C M E ET I N G

The meeting will be held in Indianapolis on Aug. 19. It is jointly sponsored by the Regenstrief Institute and the Laboratory LOINC Committee. Contact LOINC Meeting, Regenstrief Institute, 1050 Wishard Blvd., RG 5, Indianapolis, IN 46202; or e-mail loinc-meeting@ regenstrief.org; or fax (317) 630-6962; or see http://www.regenstrief. org/loinc/loincmtg.htm.

The following courses will be offered in St. Louis: The 3rd Annual International Symposium on Cerebral Revascularization (Sept. 12 15); Rehabilitation Views Integrated with Anatomical Dissections: Lumbar Spine Injections (Sept. 26); Comprehensive Brain Anatomy and Neurological Assessment (Oct. 46); Advanced Neuroanatomy and Whole Brain Dissection (Oct. 46); Interbody Fusion and Pedicle Screw Fixation of the Lumbar Spine (Oct. 1012); Advanced Techniques in Image Guided Surgery (Oct. 2427); Rehabilitation Views Integrated with Anatomical Dissections: ACL Reconstruction and Rehab (Oct. 29); TMJ/Dental (Nov. 1 and 2); Rehabilitation Views Integrated with Anatomical Dissections: TMJ & Related Soft Tissue (Nov. 15); Emergency Skills Workshop for Emergency Room Physicians and Paramedics (Nov. 20 and 21); Emergency Skills Workshop for Nurses and Physician Assistants (Nov. 22 and 23); Craniofacial Surgery and Transfacial Approaches to the Skull Base (Dec. 7 and 8). Contact Tammi Mooshegian, Practical Anatomy Workshop, Saint Louis University, 3839 Lindell Blvd., St. Louis, MO 63108; or call (314) 535-4000; or fax (314) 535-8214; or e-mail pawslab@slu.edu; or see http://pawslab.slu.edu.

JOHNS HOPKINS UNIVERSITY

The following courses will be offered in Baltimore, unless otherwise indicated: Second Annual Intensive Review in Correctional Medicine (Aug. 1517); Perioperative Management (Aspen, Colo., Aug. 1922); Eighth Annual Hepato-Biliary Update (Ocean City, Md., Aug. 31Sept. 2); Cerebrovascular Emergencies (Sept. 18); Johns Hopkins Neuroradiology Review (Sept. 2628); 30th Annual Current Topics in Geriatrics (Oct. 1012); Fourth Annual Cardiology Update (Captiva Island, Fla., Oct. 1012); 13th Annual Computed Body Tomography for the Technologist 2002 (Las Vegas, Oct. 2427); and Third Annual Topics in Psychiatry (Nov. 8 and 9). Contact Office of CME, Johns Hopkins University School of Medicine, Turner 20, 720 Rutland Ave., Baltimore, MD 21205-2195; or call (410) 955-2959; or e-mail cmenet@jhmi.edu; or fax (410) 9550807; or see http://www.med.jhu.edu/cme.

T H I R D I N T E R N AT I O N A L S C I E N T I F I C SY M P O S I U M O N T E A A N D H U M A N H E A LT H : R O L E O F F L AVO N O I D S I N T H E D I ET

The symposium will be held in Washington, D.C., on Sept. 23. Contact Robin Foroutan, Aronow and Pollock Communications, 524 Broadway, Third Floor, New York, NY 10012; or call (212) 9411414; or e-mail rforoutan@aronowandpollock.com or teameeting@ aronowandpollock.com; or see http://www.teausa.com.

O P I O I D S F O R C H R O N I C B E N I G N PA I N : DOING THE RIGHT THING?

The conference will be held in Rochester, N.H., on Sept. 24. Contact Elaine Parker, Dr. OConnells PainCare Centers, Inc., 255 Route 108, Somersworth, NH 03878; or call (603) 692-3166; or fax (603) 692-3168; or see http://www.painmd.com; or e-mail paincareconf@yahoo.com.

M AYO C L I N I C S C OT T S DA L E

The following courses will be offered in Scottsdale, Ariz.: 2002 Mayo Clinic Clinical Reviews: Summer Series (Aug. 24); 15th Annual Techniques in Advanced Laparoscopic and Gynecologic Surgery (Oct. 31Nov. 2); and The 4th Annual Southwest Nephrology Conference (Nov. 22 and 23). Contact Courtney J. Clement, Mayo School of CME, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259; or call (480) 301-4580; or fax (480) 301-8323.

E M E R G E N CY M E D I C I N E I N TO T H E 2 1 ST C E N T U RY

The conference will be held in Boston, Oct. 1215. It is jointly sponsored by Harvard Medical School, Massachusetts General Hospital, Brigham and Womens Hospital, and Beth Israel Deaconess Medical Center. Contact Harvard MED-CME, P.O. Box 825, Boston, MA 021170825; or call (617) 432-1525.

456 N Engl J Med, Vol. 347, No. 6 August 8, 2002 www.nejm.org

Downloaded from www.nejm.org on October 13, 2005 . This article is being provided free of charge for use in Indonesia. Copyright 2002 Massachusetts Medical Society. All rights reserved.