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psychological endowments of infants and the discovery of an astonishing sensitivity to human attention.

Satisfaction of affective or motivational requirements emerges as a significant component in the treatment of newborns whatever their developmental or pathologi- cal status. Normally the mother fulfils these needs automatically and unconsciously. Then the future of a baby born into hospital care depends on the mother to whom the baby is returned. A psychological transformation in pregnancy has caused her to have an acute affectional expectancy which may turn to anxiety and depression. Hospitalisation of her infant after an abnormal birth and their separation may have lasting effects on her ability to nurture and educate her infant.

The findings of the past decade require changes of attitude and belief as well as practice, not only in clinical professions, but also among psychologists. It should not be forgotten that developmental psychologists, in spite of great advances in their experimental skill with babies and sophisticated procedures for evaluating measures of development, have not always led the most enlightened approach. Indeed, paediatricians and infant psychiatrists have produced most of the evidence on early communication. The idea that babies in intensive care are stimulus-deprived was mistaken because it misrepresented the infant’s requirements and was based on a false premise about the hospital environment. The present emphasis on perceptual, cognitive and learning processes, while important and sophisticated, and capable, as Lipsitt suggests, of contributing new methods of assay and treatment, needs adjust- ment to allow study of the specific requirements of young infants in the area of affect and communication. We have to know these requirements to decide how to avoid unnecessary investment in complicated artificial environments when a mother or mother substitute would do better, and to give the best chance for the life that has been saved by caring for the parents as well as the baby. Well-planned research studies can, as Brazelton emphasises, play a part in stimulating ways to solve these problems by involving researchers, hospital staff and parents in new forms of communication.

This book will be of most interest to the professionals trying to understand each other’s needs and to those concerned with research strategy or policy. It will be of limited value for students seeking information on the behaviour of newborns and infants and on the influence of stimulation and maternal care.

C. TREVARTHEN

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Drugs in Breast Milk John T. Wilson (Ed.) MTP Press Limited, Lancaster, U.K. (1981) 110 pages

The assessment of information necessary before making decisions about the use of a

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drug by breast feeding or pregnant women can be more complicated than in many other circumstances as a second individual, infant or fetus, will almost certainly be exposed to some of the drug. The question is whether this amount of drug could produce any significant short-term or long-term adverse effects on the secondary recipient. The increasing sensitivity of techniques for measuring drug concentrations and the science of pharmacokinetics are beginning to provide a rational basis to answer this question. This book should encourage those who wish to take part in this process.

The book is composed of 15 chapters, 6 of them written by the editor although 3 of these are very brief. He gives a short account of the formation and characteristics of human breast milk as it may be relevant to drug studies. The best part of the book is his description of how the extent of drug transfer into human breast milk can be predicted from the physicochemical properties of a drug and of milk and phar- macokinetic modelling of concentrations versus time. Much of this is built upon animal studies and is yet to be directly measured in the human. This is followed by 8 chapters, mainly by other authors, reviewing the literature as to the concentrations of actual drugs in human breast milk. It is noticeable that much of the information is based on reports from single or a few individuals and many important drugs are not mentioned as the data is not available. The title of the penultimate chapter looks promising - Consequences of Breast Milk Drug Dosing on Infant Behaviour and Development - but is concerned almost entirely with animal studies and therefore out of step with the rest of the book.

T.hose people interested in research on the pharmacokinetics of drugs in breast milk will find this a useful book, particularly because of its comprehensive coverage. However, those looking for a critical appraisal of the hazards to the infant of a specific drug or drugs in general will only occasionally be enlightened. The editor only devotes one short section to the calculation of the daily dose of drug likely to be received by a breast feeding infant and how, by comparison of this with any recommended infant therapeutic dosage, the significance of exposure can be de- termined. Unfortunately, most of the quantitative data on specific drugs is presented as the much less valuable, and sometimes misleading, ratio of concentrations in milk to maternal plasma. Clinical pharmacokineticists, having largely developed the science of pharmacokinetics, have often placed too much emphasis on the measure- ment and modelling of drug concentrations in fluids, treating this as an end in itself rather than as a means to the assessment of benefits and hazards of drugs. This is reflected in this book as there is little comment on the measurement of effects in neonates resulting from drugs taken via breast milk. The sequel ‘Drugs in Breast Milk and the Infant’ should prove worthy of their science and be more valuable therapeutically.

M. HOLLINGSWORTH

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