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Psychologic care during infancy and childhood
BOOK REVIEWS
429
They give an excellent historical review of the discovery and scientific studies of vitamin K which finally led up to its therapeutic use in conditions of hypoprothrombinemia and specifically hemorrhagic diseases of the newborn. The authors critically review the various claims for therapeutic effectiveness of this vitamin for other types of hemorrhagic conditions such as hemophilia, purpuric hemorrhagic states, and hemorrhage connected with ieteric diseases. They found that its effectiveness is limited almost entirely to con~ditions due to true hypothrombinemia. The therapeutic use of vitamin K both as a prophylactic and a therapeutic agent are described in excellent detail and are supported by a large amount of case material Vitamin K given to the parturient mother four or twelve hours before the completion of the birth will often prevent appearance of hemorrhagic disease in the newborn. t f it is not given to the mother, it is g i v e n to the i n f a n t one-half hour after birth; five milligrams of the hydronaphthoquinone salt intramuscular]y or 10 rag. of the diacetate salt orally. Vitamin K should be always used if the birth is premature or is prolonged or when obstetric operative procedures are used. In these conditions vitamin K should be administered four hours before delivery. I f this is not possible, an intravenous injection of a water-soluble preparation should be given five minutes before the birth of the infant. I n three hundred and forty-eight newborn infants, ranging in age from birth to 15 days, the authors found the average prothrombin time to be 48.5 ~eeonds. I n ten premature infants, ranging in age from birth to 20 days, the prothrombin time was 43.3 seconds. The authors conclude that in the early days of i n f a n t life, hypoprothrombinemia is a normal state. They are of the opinion that the maximal physiologic hypoprothrombinemia occurs in the infant between thirty-six and seventy-two hours a f t e r birth. A t the time of birth the prothrombin time seems to be in the neighborhood of thirty seconds, which is the normal figure. Prolongation of it occurs only after birth. The authors consider the dividing line between physiologic a~d pathologic hypoprothrombinemia to be about ninety seconds. I n their opinion, hypoprothrombinemia is not the only factor causing hemorrhagic manifestations in the newborn infant but that actually in the majority of cases of hemorrhagic disease of the newborn there is at least a tranistory hypoprothrombinemia. u K is not the only substance which influences prothrombin formation in the liver. The authors have found that both physiologic and pathologic hypoprothrombinemia can be influenced by the injection of 2 methyl 1,4 naphthoquinone. They believe that vitamin K or similarly acting substances, i f properly and timely used, will, in the majority of cases, suffice for the treatment of most hemorrhagic discuses of the newborn and will make added blood transfusion unnecessary. SCHLUTZ.
Psychologic Care During Infancy and Childhood. Ruth Morris Bakwin and H a r r y Bakwin, New York, 1942, D. Appleton-Century Co., Inc., 289 pages. Price, $3.50. This book, prepared by two experienced pediatricians, is primarily designed to interest and instruct the pediatrician in the promotion of optional psychologic health in the child. To this end it will pro~e an interesting, instructive, readable description of most of the behavior reactions of children and a discussion of the more important psychologic aspects of child care. The publication of this book bears
430
~PHE JOURNAL OF PEDIATRICS
evidence of the increasing interest and responsibility which is being a s s u m e d by pediatricians in a movement toward the development of goad mental health and emotional stability in children and adolescents. The authors have placed considerable emphasis on the application of psychologic insights to the common-sense understanding and management of the emotional problems which daily confront the parent. However, it is not always clear how the pediatrician can translate this understanding to the parent in order to help him acquire new attitudes and new methods of approach to the problems at hand. There is considerable emphasis placed on the attitude which the parent should have, such as " a s s u m i n g a calm and unealotional a t t i t u d e , " but the book did not seem to be too helpful in its discussion of the art of helping parents move from the attitudes t h e y have to the ones they should have. The authors give adequate emphasis to the need a child has for love, affection, and sympathetic understanding from the parent. This is brought out continually and indicates the authors' real appreeiatlon of the basic values in the parent-child relation. The range of subject material is very wide and includes brief discussion of the majority of topics and behavior reactions encountered in the average ehild. The chapters, particularly those on fear, insecurity, and discipline, are well handled and contain a good deal of good common sense. Mental testing is discussed and intelligence tests in common use are listed, tlowever, there is little emphasis placed upon the effect which emotional difficulty will produce in the I.Q. test result. This subject is but briefly considered under the heading Failure in School. On the whole, the therapeutic approach recommended appears to place confidence in the authoritative and manipulative approach, somewhat overoptimistically it would seem, particularly where the more serious problems receive the same emphasis as the normal everyday type of problem. The major emphasis throughout is on '~pointing o u t " arLd giving' advice. But this undue optimism is excusable if one considers thdt there is implied in this point of view a confidence in the parents who, with good will, a r e eager to help their children even though that involves the difficult adoption of new attitudes and methods. The assumption of confidence in what parents and children can and will do in the solution of their difficulties is assuredly tho attitude which will be of basic value to the pe.diatrician. In the final chapter the authors touch upon a most important aspect of this whole subject, the handling of sick children in the hospital. What they say is good but it is regrettable that more attention was not devoted to this highly important and neglected aspect of pediatric practice. While the authors cover every degree of psychologic difficulty in children, at no point is there any stress laid on the need of more specialized psychiatric training for the pediatrician, nor do they in.dicate that the more serious neurotic disturbances, which are described, really fall outside the realm of pediatric practice and require the attention of the child psychiatrist. The chief value of this book is in presenting some of the common situations encountered in most normal children and parents. The pediatrician will find much that is of value. The book will be much less valuable for those who want a deeper understanding "of the more serious problems such as anorexia nervosa. Lawrence Frank has written an excellent forewor.d Which stresses the pediatricians greater opportunity ~'to further the movement toward wiser, saner, and more wholesome nurture and rearing of infants and children in and through the f a m i l y . " This book will be useful in stimulating more pediatricians to move in that direction. ALLEN.
429
They give an excellent historical review of the discovery and scientific studies of vitamin K which finally led up to its therapeutic use in conditions of hypoprothrombinemia and specifically hemorrhagic diseases of the newborn. The authors critically review the various claims for therapeutic effectiveness of this vitamin for other types of hemorrhagic conditions such as hemophilia, purpuric hemorrhagic states, and hemorrhage connected with ieteric diseases. They found that its effectiveness is limited almost entirely to con~ditions due to true hypothrombinemia. The therapeutic use of vitamin K both as a prophylactic and a therapeutic agent are described in excellent detail and are supported by a large amount of case material Vitamin K given to the parturient mother four or twelve hours before the completion of the birth will often prevent appearance of hemorrhagic disease in the newborn. t f it is not given to the mother, it is g i v e n to the i n f a n t one-half hour after birth; five milligrams of the hydronaphthoquinone salt intramuscular]y or 10 rag. of the diacetate salt orally. Vitamin K should be always used if the birth is premature or is prolonged or when obstetric operative procedures are used. In these conditions vitamin K should be administered four hours before delivery. I f this is not possible, an intravenous injection of a water-soluble preparation should be given five minutes before the birth of the infant. I n three hundred and forty-eight newborn infants, ranging in age from birth to 15 days, the authors found the average prothrombin time to be 48.5 ~eeonds. I n ten premature infants, ranging in age from birth to 20 days, the prothrombin time was 43.3 seconds. The authors conclude that in the early days of i n f a n t life, hypoprothrombinemia is a normal state. They are of the opinion that the maximal physiologic hypoprothrombinemia occurs in the infant between thirty-six and seventy-two hours a f t e r birth. A t the time of birth the prothrombin time seems to be in the neighborhood of thirty seconds, which is the normal figure. Prolongation of it occurs only after birth. The authors consider the dividing line between physiologic a~d pathologic hypoprothrombinemia to be about ninety seconds. I n their opinion, hypoprothrombinemia is not the only factor causing hemorrhagic manifestations in the newborn infant but that actually in the majority of cases of hemorrhagic disease of the newborn there is at least a tranistory hypoprothrombinemia. u K is not the only substance which influences prothrombin formation in the liver. The authors have found that both physiologic and pathologic hypoprothrombinemia can be influenced by the injection of 2 methyl 1,4 naphthoquinone. They believe that vitamin K or similarly acting substances, i f properly and timely used, will, in the majority of cases, suffice for the treatment of most hemorrhagic discuses of the newborn and will make added blood transfusion unnecessary. SCHLUTZ.
Psychologic Care During Infancy and Childhood. Ruth Morris Bakwin and H a r r y Bakwin, New York, 1942, D. Appleton-Century Co., Inc., 289 pages. Price, $3.50. This book, prepared by two experienced pediatricians, is primarily designed to interest and instruct the pediatrician in the promotion of optional psychologic health in the child. To this end it will pro~e an interesting, instructive, readable description of most of the behavior reactions of children and a discussion of the more important psychologic aspects of child care. The publication of this book bears
430
~PHE JOURNAL OF PEDIATRICS
evidence of the increasing interest and responsibility which is being a s s u m e d by pediatricians in a movement toward the development of goad mental health and emotional stability in children and adolescents. The authors have placed considerable emphasis on the application of psychologic insights to the common-sense understanding and management of the emotional problems which daily confront the parent. However, it is not always clear how the pediatrician can translate this understanding to the parent in order to help him acquire new attitudes and new methods of approach to the problems at hand. There is considerable emphasis placed on the attitude which the parent should have, such as " a s s u m i n g a calm and unealotional a t t i t u d e , " but the book did not seem to be too helpful in its discussion of the art of helping parents move from the attitudes t h e y have to the ones they should have. The authors give adequate emphasis to the need a child has for love, affection, and sympathetic understanding from the parent. This is brought out continually and indicates the authors' real appreeiatlon of the basic values in the parent-child relation. The range of subject material is very wide and includes brief discussion of the majority of topics and behavior reactions encountered in the average ehild. The chapters, particularly those on fear, insecurity, and discipline, are well handled and contain a good deal of good common sense. Mental testing is discussed and intelligence tests in common use are listed, tlowever, there is little emphasis placed upon the effect which emotional difficulty will produce in the I.Q. test result. This subject is but briefly considered under the heading Failure in School. On the whole, the therapeutic approach recommended appears to place confidence in the authoritative and manipulative approach, somewhat overoptimistically it would seem, particularly where the more serious problems receive the same emphasis as the normal everyday type of problem. The major emphasis throughout is on '~pointing o u t " arLd giving' advice. But this undue optimism is excusable if one considers thdt there is implied in this point of view a confidence in the parents who, with good will, a r e eager to help their children even though that involves the difficult adoption of new attitudes and methods. The assumption of confidence in what parents and children can and will do in the solution of their difficulties is assuredly tho attitude which will be of basic value to the pe.diatrician. In the final chapter the authors touch upon a most important aspect of this whole subject, the handling of sick children in the hospital. What they say is good but it is regrettable that more attention was not devoted to this highly important and neglected aspect of pediatric practice. While the authors cover every degree of psychologic difficulty in children, at no point is there any stress laid on the need of more specialized psychiatric training for the pediatrician, nor do they in.dicate that the more serious neurotic disturbances, which are described, really fall outside the realm of pediatric practice and require the attention of the child psychiatrist. The chief value of this book is in presenting some of the common situations encountered in most normal children and parents. The pediatrician will find much that is of value. The book will be much less valuable for those who want a deeper understanding "of the more serious problems such as anorexia nervosa. Lawrence Frank has written an excellent forewor.d Which stresses the pediatricians greater opportunity ~'to further the movement toward wiser, saner, and more wholesome nurture and rearing of infants and children in and through the f a m i l y . " This book will be useful in stimulating more pediatricians to move in that direction. ALLEN.