Spock's sixth edition mixes new advice, proven wisdom

THE BALTIMORE EVENING SUN

Dr. Spock brings his bible on baby and child care into the 1990s with the same comforting words he used to introduce it to parents of the last five decades: "Trust yourself, you know more than you think you do."

At the end of the just-published sixth edition of "Dr. Spock's Baby and Child Care," (Pocket Books, New York, $6.99), however, there isn't much comfort. There is, instead, a detailed list of the "unprecedented strains on American families today" and an exhortation to parents to become politically active and to rear children "to become kind, cooperative, feeling people. . .who will not let their jobs distort their lives."

Between the promise and the politics, this edition of Dr. Benjamin Spock's book still walks parents through croup, chicken pox and sleepless nights, covering much of the ground the other editions have since the first was published in 1945.

It also breaks new ground with discussions of psycho-social developments such as step-family dynamics, homosexuality and open adoptions, as well as with medical updates on AIDS, immunizations, headaches and choking.

There is much praise for breast-feeding, new information on children of divorce and caveats about passive smoke and quality time gone mad.

The new book has about 80 more pages than the 1985 edition but still meets one of its prime criteria: "This book can't ever get fatter than a mother can hold in one hand with a screaming baby in the other," said Dr. Michael Rothenberg, Dr. Spock's co-author and heir apparent to his legacy.

Dr. Rothenberg, professor emeritus of pediatrics and psychiatry at the University of Washington School of Medicine in Seattle, first collaborated with Dr. Spock on the '85 edition. But he seems to have been the driving force behind this book, as the 88-year-old Dr. Spock has all but passed his torch to a new generation.

"It was my responsibility to make the initial recommendation whenever I thought it was time to revise the book," said the 65-year-old Dr. Rothenberg during a telephone interview. In July 1989, "it became clear to me that we had more than enough new material," he added.

Although Dr. Spock told his colleague to edit the book as he saw fit and send him a manuscript to look over, Dr. Rothenberg didn't let the venerable baby doctor off so easily. He sent him each chapter as it was revised over the last two years. "Ben, in fact, read every word of the manuscript," and originated the section on passive smoking and the final statements himself, Dr. Rothenberg added.

Despite Dr. Rothenberg's considerable influence in this edition, the doctors speak with one voice, as "I" and Dr. Spock's original, almost chatty, style endures.

Dr. Rothenberg added a section on whining, hardly a problem peculiar to the '90s, but one that had escaped attention all these years. His wife noted the omission, he said, while the couple was returning from the home of friends, who have youngsters inclined to whine. When he went to the book, Dr. Rothenberg discovered his wife was right, and set about remedying the situation.

Now the book defines whining -- most parents won't need a definition -- "as a pattern of excessive demandingness that takes weeks and months to become fully established and quite a while to overcome." It suggests that some parents tolerate, and even foster, whining because they feel guilty or inadequate and cannot muster the firm, but friendly, manner needed to quell it.

To prevent a child's whining and a parent's subsequent frustration, the book advises: "Set limits confidently and

promptly before their demands become incessant and petulant."

This edition has a new, separate section on preventing injuries, which are "the leading cause of death in childhood, after age 1," said Dr. Rothenberg. Most injuries, according to the book, result from automobile accidents, fires and drownings. Beyond the obvious preventive measures, such as using safety seats, wearing seat belts and bicycle helmets and installing smoke detectors, the chapter includes other firm, succinct suggestions for preventing home accidents:

* Never use baby walkers. They let children reach items they otherwise would not be able to and raise the child's center of gravity so he can fall more easily than usual, especially down a flight of stairs.

* "Plastic bags cause suffocation of babies and children. So do unused refrigerators and freezers."

* Feel the temperature of bath water just before putting a baby in it.

* Turn the temperature of your hot water heater down to 120 to 125 degrees to prevent scalding.

* Never drink hot coffee or tea with a child in your lap.

In this edition, as in the last, Dr. Spock deals with permissiveness, for which he has been often chided, by saying in an introduction that those who have used his book do not consider him permissive. In the new edition, there is a section titled "Strict or Casual Discipline?" That same section was called "Strictness or Permissiveness" in the '85 edition.

Through the revisions, the book's balance between medical advice and social and developmental direction has remained about the same, said Dr. Rothenberg, who followed and admired Dr. Spock long before he was invited to collaborate with him.

"The psycho-social developmental core of the book was always there. That's what's been maintained through all six [editions]," he added.

Over nearly a half-century of babies and their parents, Dr. Spock's book has sold more than 40 million copies to become perhaps the best best seller of this century, says its publisher, Pocket Books.

New entries in 'Dr. Spock'

The sixth edition of "Dr. Spock's Baby and Child Care" offers parents plenty of long-standing advice and some that is new for the '90s. Here are some new entries in Dr. Spock's venerable book:

* Quality time: "The idea of quality time in itself is fine. But I'm concerned that a few conscientious, hard-working parents take it as an obligation -- whenever they're at home or for a certain number of hours daily -- to be talking, playing, reading with their children, long after patience and enjoyment have run out."

* Vaccinations: ". . . Some parents are alarmed and confused . . . about a few children who have had bad reactions to a particular vaccine. Some of these parents then decide not to give their children any immunization, for fear that the immunization will make the child sicker than the disease would have. I think that this is a mistake because we know that in the vast majority of cases the disease is much more dangerous to many more children than the rare bad reaction. . ."

* Homosexuality: "If you think your adolescent may be a homosexual or lesbian, the first thing to do is to get your own fears and anxieties under control."

* "Passive" smoke: "Children who live with smokers are more subject to bronchitis, pneumonia, chronic cough and middle ear infections. They have higher than average cholesterol levels in their blood."

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