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By Siegfried M Pueschel.
Paul H Brookes Publishing Co
£17.95
ISBN 1 55766 452 8

This is a disappointing book. Dr Pueschel, a US paediatrician who has made many important contributions to our understanding of the medical needs of disabled children, has produced a new edition of his well-established handbook. His fellow contributors were asked to revise the chapters they wrote for the 1990 edition to provide an up-to-the-minute guide for the parents of children with Down's syndrome.

The book comprises 22 chapters, eight of which have been written by Dr Pueschel himself. Although there are some good chapters - for example, on recreation and on supported employment - many of the contributions failed to inspire me. While some authors have seized the opportunity to refresh their chapters, many contributors do not address contemporary issues. Young people with Down's syndrome are now fluent in speaking up for themselves and I was disappointed to find no discussion of the remarkable contribution that self-advocacy has made to their lives.

As a consequence of improvements in health care, children born with Down's syndrome now not only have a much better life expectancy, but also enjoy more opportunities to be included in community life. Their parents deserve a more up-to-date account of their needs.

Oliver Russell is a consultant psychiatrist.