From Interlibrary loan, I have received Dr. Gary Chan's 1997 book Lactation: The Breast-Feeding Manual for Health Professionals. It is published by Precept Press, Chicago. Chan is the editor and wrote some of the chapters. He is a professor of pediatrics at the College of Medicine, University of Utah in Salt Lake City. Other contributors, all from Salt Lake City as well, are Pamela Binns, Licensed Occupational Therapist, Alison Bunnell, Registered Dietician, Delma Johnson, Registered Nurse and "Certified Lactation Educator," Lauri Moyer-Mileur, Registered Dietician and Asst. Professor of Food and Nutrition, and Laura Wham, Registered Nurse and "Certified Lactation Specialist." Thus, no IBCLCs. It appears to have been written as a "quick and dirty" version of Lawrence. In the acknowledgements he thanks the staff of Wellstart International in San Diego, California, and later in the book he has some forms from Chele Marmet (forms for breast assessment and infant's physical assessment) that say "Used with permission." It is a strange little book. Some chapters are written in prose, with paragraphs and complete sentences. Other parts are like the outline from a talk. Some parts sound up-to-date, others not. Some chapters cite sources at the end such as Ruth Lawrence, Riordan and Auerbach, etc., but the chapter on drugs in breast milk does not cite Tom Hale. Chapters include: Section 1. Prinicples of Lactation 1. Anatomy and physiology of lactation (Chan) 2. Benefits of lactation and human milk composition (Chan) 3. History and examination of the breast-feeding mother and infant (Wham) 4. Dietary recommendations for lactating women and nursing infants (Chan) 5. Medical contraindications to breast-feeding (Chan) 6. The effects of drugs and herbs on lactation Chan and Bunnell) 7. Human milk expression and storage (Johnson) Section 2. Sustaining healthful lactation 8. Engorgement (Chan) 9. Sore nipples (Chan) 10. Insufficient milk supply (Chan) 11. Mastitis (Chan) 12. Feeding Twins and Triplets (Chan) 13. Relactation (Chan) 14. Weaning and suppression of lactation (Chan) Section 3. Special lactation issues 15. Parent education on breast-feeding issues concerning the infant (Chan) 16. Jaundice and breast-feeding (Chan) 17. Failure to thrive (Chan) 18. Human milk and the preterm infant (Moyer-Mileur) 19. Feeding the preterm infant (Binns) 20. Feedint the infant with cleft lip, cleft palate, or neurologic impairment (Bunnell) Section 4. Lactation Support Groups [this is a wonderful, alphabetical list of many different organizations -- great for photocopying and keeping handy] Index I have not read this book from cover to cover, but here are a few gems: Chapter 1 begins: "Lactation is the physiologic completion of the reproductive cycle. The breast develops and readies itself to nourish the infant by 16 weeks into the pregnancy. The breast is inactive by hormones (sic) that suppress the lactation response. . . ." Chapter two includes growth charts for breastfed babies adapted from Dewey et al. 1992 -- Chan says: "By 12 months, breast-fed infants have comparable length and head circumference gains as formula-fed infants but their weight is about the 10th percentile when plotted on standard growth curves. Because of the difference in growth, growth curves for exclusively breast-fed infants HAVE BEEN ESTABLISHED." (my emphasis) Y'all know this is one of my pet peeves. The DARLING research is by no means comprehensive enough, or done on a big enough sample to derive growth charts from. But -- there they are, plain as day, with no disclaimers. Chapter Five, Medical Contrindications to Breast-Feeding Includes the following: Maternal breast cancer -- "There are concerns about the passage of cancer cells in the milk to the infnat with subsequent development of breast cancer in the infant. However, studies do not support this concern. Development of breast cancer is associated with family and pregnancy history, and not the breast-feeding history." That's the sum total on this topic. Maternal AIDS Mother with Hepatitis C Virus - he says you shouldn't nurse if you have Hepatitis C, which is not *my* understanding of the current literature. He cites the Committee on Infectious Disease Report, American Academy of Pediatrics Redbook, edition 23, 1994. Mothers with active cytamegalovirus infection who have delivered a preterm infant Mothers with primary herpes simplex mucocutaneous lesions or herpetic lesions on the breasts (he says they can breastfeed after all their lesions have healed) Maternal medications -- see chapter six "Infant with Metabolic Disorders such as galactosemia and phenylketonuria should be on specialized formulas that eliminate the carbohydrate or protein the infant cannot metabolize." The drugs chapter says the information is derived from P.O. Anderson's article, Drug use during breast-feeding, Clinical Pharmacology, 1991, and an AAP report from 1989, and the information on herbs comes mostly from a 1983 publication. Where is Tom Hale's book?? Skipping to chapter 14 on weaning, which I think is truly interesting: "Weaning is the process by which substantial nutrition other than breast milk is introduced with the final goal of breast-feeding cessation. Weaning occurs gradually over weeks or months. The decision to wean is based on cultural and psychosocial issues. In many cultures, a subsequent pregnancy signals the time for weaning. In other cultures, the continuation of breast-feeding is determined by mutual consent of the mother and child. There is no set timetable indicating when to wean. It may start anytime during the first two to four years of life." [YES, he really says that!!!! Whee!!!!] "As health care providers, we should provide appropriate information so that the mother can make her own decision." He cites Lawrence and Riordan and Auerbach as sources. But, darn, in the next chapter he writes: "Almost half of all infants do not sleep through the night until three to four months of age." Anyway . . . . a mixed bag. I'd be interested in an evaluation of the clinical information from the IBCLCs on the list. Katherine A. Dettwyler, Ph.D. Associate Professor of Anthropology and Nutrition Texas A&M University