Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources

Wow! If only this book had been around when we were overseas in Namibia and India respectively… This is a book aimed at doctors, senior nurses, and other senior health workers who are responsible for the care of young children in developing countries. Edited by WHO, the contributors are eminent paediatricians from around the world and it shows. It has up to date WHO guidelines on all the common illnesses health workers would come up against. The approach is practical and detailed, the language clear and non‐patronising. The book measures 10.5cm×15cm×2cm thick and every millimetre is used to its full potential; every sentence has a message, every diagram is relevant, every table or chart is clear and space‐saving. Yet in the pressure for space, important basic paediatric values are not forgotten, e.g. the advice on reviewing the Mother's Card: “Watch to see if the mother looks worried or puzzled. If so encourage questions”. The cleverly thought out front and back flaps open up to reveal, respectively, neonatal resuscitation paired with triage of sick children, and emergency drugs alongside intravenous fluids compositions. There is also a chart for the clinician to write in his/her local antibiotic policy. The 12 chapters detail the management of the main causes of childhood morbidity and mortality and are colour coded for ease of reference. They cover breathing difficulties, diarrhoea, fever, severe malnutrition, neonatal and surgical problems, and there is a particularly comprehensive chapter on children with HIV/AIDS including practical palliative care. The first two chapters are on emergency conditions and the diagnostic approach to the sick child. There is a chapter on supportive care (nutrition, fluids, pain, blood transfusion, and a very helpful section on improvised toys and play therapy) and an inspiring chapter on counselling and discharge from hospital. This is an aspect of care which so often gets left out in areas of the world with limited resources because the emphasis is on getting on with treating the queue of people still waiting in the outpatients department. (And then we wonder why we are seeing the same children over and over again…) Practical procedures and some drug dosages are usefully covered in the appendices. We struggled to find anything to criticise in this book. In most areas of the world clinicians now have some sort of internet access (indeed this is more likely than having a good library nearby) and we would have liked to see more specific references and website links in the main body of the text. Some of the guidelines are new (to us at any rate!), such as artemisinin based combination therapy as first line treatment in non‐severe malaria and routine zinc supplementation in diarrhoea. We wondered if big changes to guidelines like this could be emphasised a bit more. Some common issues were not mentioned in the book such as umbilical granuloma, undescended testes in the surgical chapter, and steroids for the management of neurotuberculosis in the TB section (it is mentioned under generic meningitis information later). Other things such as Kaposi sarcoma possibly get a little too much space relative to their prevalence in young children. Overall, as a handbook for junior doctors we felt that this book inspires confidence. The practical guidelines are easy to follow and even the newest of doctors should be able to safely rehydrate a malnourished child by following the instructions therein. This book is an absolute must for anyone caring for children in areas of the world where resources are limited. If you are toying with the idea of doing a stint overseas (VSO/RCPCH fellowship, for example) this book will convince you to go. It speaks of an overwhelmingly “real” medicine where children are properly sick, where your skills count, where you can change lives, and where the banding of your rota pales into insignificance. On the practical side, we thumbed through the book and bent its spine unforgivingly to write this review and our copy hasn't fallen apart yet. As far as we can tell, all the cross references to other pages or sections are accurate and, what's more, it does actually fit into your pocket. It comes highly recommended.