Author: M.K.C. Nair and Ranjan Kumar Pejaver. Bangalore, Prism Books Private Limited, 2000, Pages 222, Price Rs. 30/-.

This book is timely as so far the discipline of child development and its assessment and management has been regarded as the domain of specialists in that field and has not percolated down to the people working with children in the community and hospitals. There are of course follow-up studies of individual researchers particularly in low birth weight babies but very little in the community setting. Many at risk newborn babies now survive because of better neonatal care and so developmental delays, behavioral problems, hyperkinetic disorders, etc. are also likely to increase not to speak of frank cases of cerebral palsy. It is therefore imperative to develop facilities for diagnosis and management of these conditions and impart relevant training.

WHO estimates that 10% of the world’s population has some form of disability. The authors have found this in 3.8% in their experience. They bemoan the fact that childhood disability has not received due attention of planners and policy makers. In a study of one Integrated Child Development Services (ICDS) block in Kerala, the authors found 262 abnormalities, speech and language problems being the predominant ones followed by orthopedic deformities, visual and hearing problems, cerebral palsy, mental retardation and others. The main policy implication is that the burden of disability for one panchayat was only 39 and so it is feasible to do relevant interventions at the community level.

Neurodevelomental follow-up and early interventional therapy both from the therapist and the family is essential. Traditional massage, carrying the baby astride the hip, fondling and caressing by the mother (the authors seem to omit the role of the father and other family members) will go a long way in preventing neuro-developmental handicap. These have to be supported by different modalities of therapy and early intervention. The stress is on early diagnosis and management according to the facilities available.

Several interventions for infant stimulation in neonatal ICU in developed countries have been described which it is hoped will be available in India in the not too distant future. However, hospital deliveries form a small minority (except in Kerala with which the authors are familiar).

In the chapter on developmental delay there is a review of risk facotrs-genetic and metabolic disorders, prenatal diagnosis, going on to biological risk, low birth weight and the recommended nutrient intakes of preterm babies, etc. Followed by Sarnet stages of hypoxic-ischemic encephalopathy and grading of brain hemorrhage. Also included in this chapter is a description of ICDS, the relevance of which at this point is not clear.

The authors describe a screening test with 17 items which an anganwadi worker (AWW) can be trained to administer. All children can thus be evaluated for school readiness. Teachers and AWWs can be taught to use draw a man test which is a good test for development at that point.

Although developmental delay is most likely to be found among babies with risk factors, the large majority born with a risk factor, are likely to develop normally. On the other hand cerebral palsy and mental retardation are often observed among the large group of babies born normally without any apparent risk factor.

The book is not just didactic, but is based on down to earth experience and suggestions have been made as to the inputs needed at the community level to assess children and to be able to help those in need. Utilization of ICDS program according to the authors is the answer. However, even though ICDS is a child development program, its performance in that field has not been tested or utilized, nor any relevant training given to the AWWs and others. The good experience in a development block in Kerala with a lot of inputs cannot be replicated in other situations. Even in Kerala it should be evaluated on a much larger sample and not just the pilot project. Role of the health sector does not even get a mention.

The book tends to be repetitive in parts but is sure to improve in subsequent editions. The cover is very pleasant but the line drawings could be improved. There is a list of references at the end of each chapter.

On the whole a significant addition to the literature on child development with a down to earth approach.

Shanti Ghosh,
5 Sri Aurobindo Marg,