Children less than 3 years old are most vulnerable to drowning, and organized efforts to reduce the toll are indicated. Heretofore, swimming instruction has concentration on school-aged children, but in recent years some emphasis has been placed on teaching younger children to swim, even during the first year of life. Although it may be possible to teach young infants to propel themselves and keep their heads above water, infants cannot be expected to learn the elements of water safety or to react appropriately in emergencies. No young child, particularly those who are preschool aged, can ever be considered "water safe." Parents may develop a false sense of security if they feel their young child can "swim" a few strokes. Additional problems may be associated with admission of infants to public swimming pools. Incontinent infants pose an aesthetic problem and make it difficult to maintain the effectiveness of chlorination. The Committee recognizes the increasing populaity of swimming programs for infants and the enjoyment of the parent and child in this shared activity, and makes the following recommendations: 1. If a parent wishes to enroll his/her infant in a water adjustment and swimming program, it should be on a one-to-one basis with the parent or a responsible adult. Organized group swimming instruction should be reserved for children more than 3 years old. 2. Instruction should be carried out by trained instructors in properly maintained pools. 3. Infants with known medical problems should receive clearance from their physician. 4. Controlled studies clarifying the possible risks to infants from swimming programs should be carried out as soon as possible.
In January 1964, the Surgeon General's office released its report demonstrating the strong potential relationship between cigarette smoking and lung cancer as well as the pulmonary and cardiovascular diseases which afflict thousands each year.1 Since that time, an estimated 30 million Americans have quit smoking; but, during the last two years, there has been a noticeable increase in per capita cigarette consumption among women and teen-age girls.2 Every day 3,200 adolescents between the ages of 12 and 18 take up smoking (exclusive of those who are just experimenting with smoking, the 10- to 12-year-olds).3 The Bureau of Census estimates that the number of teen-agers smoking rose from 3 million to approximately 4 million between 1968 and 1972. The proportion of smokers in the 12 to 18 age group increased from 14.7% to 15.7% among boys and 8.4% to 13.3% among girls.4 Analysis of research by the Department of Health, Education, and Welfare on teen-age populations indicates there are many environmental factors that affect the initiation of the smoking habit; however, by far the strongest influence is the smoking behavior of parents and siblings.5 If both parents smoke, the teen-ager has about twice the likelihood of being a smoker than if neither parent smokes (the rates are 18.4% to 9.8% respectively). If an older brother or sister smokes, the teen-ager is twice as likely to become a smoker himself.5 When the combined effect of smoking of parents and older siblings is considered, the concept of family patterns is reinforced. The lowest level of smoking is found among teen-agers who live in nonsmoking households.
A physician's recommendations concerning athletic activity for normal, healthy children must take into account a wide range of individual differences in size, age, coordination, stage of maturation, and level of physical and mental development. However, when the child has a skeletal abnormality, the physician must also consider the broad spectrum of variations of the disorder itself. For example, a child with rheumatoid arthritis may be in acute pain with systemic symptoms, may have no evidence of activity, may have mild monarticular arthritis that terminates after two or three years, or may have every joint involved without let-up for ten years. The following principles will serve as a guide to the physician as he discusses athletic competition with the child and his parents. It is important to distinguish between participation in athletic activities and participation in competitive sports. Competition is often highly motivating and may be a means for promoting self-satisfaction and developing muscles and coordination. But, this is so only if the child is successful in his competitive efforts. If a child is condemned to constant failure because of limitations in strength, endurance, range of motion, coordination, or for any cause, participation in competitive activities can be destructive to his self-image. A child with limited ability should be guided to an appropriate level of activities with no competition or with a goal of competition against one's previous performance. A child with a serious handicap usually recognizes that he has no opportunity to succeed; however, the child with a mild handicap which keeps him from ever being first or causes him always to come in last may experience considerable frustration and discouragement.
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