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.

Psychiatric symptoms are historically thought a relative contraindication to DBS for advanced Parkinson's disease (PD). However, in the case of drug-induced mental illness, DBS may provide an acceptable alternative for the treatment of motor symptoms. This allows reduction of pharmacological dopaminergic therapy that might otherwise cause negative psychiatric consequences. For example, DBS is increasingly used to ameliorate specific complications of PD treatment, such as impulse control disorders. We present a series of 3 cases of young male patients who developed Othello syndrome (OS) during treatment with dopamine agonists. In each case, the OS resolved with withdrawal of the offending drug. Subsequent treatment with bilateral STN DBS improved motor symptoms and allowed reduction in their dopaminergic drug regimen. We therefore propose that drug-induced psychopathology may be an indication (rather than a contraindication) for DBS in selected cases.

In September 1977, the Academy published a statement calling for a ban on the use of trampolines in schools because of the high number of quadriplegic injuries caused by this apparatus.1 A considerable amount of thought and action resulted. The Academy does not endorse trampoline use, but a revision of the Academy's position to allow for a trial period of limited and controlled use by schools seems appropriate. However, careful assessment of the incidence and severity of injury must continue during this trial period. The trampoline is a potentially dangerous apparatus, and its use demands the following precautions: 1. The trampoline should not be a part of routine physical education classes. 2. The trampoline has no place in competitive sports. 3. The trampoline should never be used in home or recreational settings. 4. Highly trained personnel who have been instructed in all aspects of trampoline safety must be present, when the apparatus is used. 5. Maneuvers, especially the somersault, that have a high potential for serious injury should be attempted only by those qualified to become skilled performers. 6. The trampoline must be secured when not in use, and it must be well maintained. 7. Only schools or sports activities complying with the foregoing recommendations should have trampolines.

Heat-induced ifiness is preventable. Physicians, teachers, coaches, and parents must be made aware of the potential hazards of high-intensity exercise in hot climates and of the measures needed to prevent heat-related illness in preadolescents. Because of the following morphologic and functional differences, exercising children do not adapt to extremes of temperature as effectively as adults when exposed to a high-climatic heat stress.1 1. Children have a greater surface area-mass ratio than adults, which induces a greater heat transfer between the environment and the body. 2. Children produce more metabolic heat per mass unit than adults when walking or running.2 3. Sweating capacity is not as great in children as in adults.3,4 4. The capacity to convey heat by blood from the body core to the skin is reduced in the exercising child.4,5 The foregoing characteristics do not interfere with the ability of the exercising child to dissipate heat effectively in a neutral or mildly warm climate. However, when air temperature exceeds skin temperature, children have less tolerance to exercise than do adults. The greater the temperature gradient between the air and the skin, the greater the effect on the child.4,6,7 Upon transition to a warmer climate, any exercising individual must allow time for conditioning for heat (acclimatization). Intense and prolonged exercise undertaken before acclimatization may be detrimental to health and might even lead to fatal heat stroke.8 Although children can acclimatize to exercise in the heat,6,9 the rate of their acclimatization is slower than that of adults.1 Therefore, a child will need more exposures to the new climate to sufficiently acclimatize.

Achieving fitness is a way of life, not a fad or a brief change in one's way of doing things. And, an early start is imperative. A flaw in our present system of health care is the emphasis on evaluation of anatomic or organic soundness and the presence or absence of disease–with less regard for the quality of physiologic function. In other words, dynamic performance is frequently ignored after the organic condition has been determined. An infant or child may well be regarded as healthy with the proper immunizations and absence of disease. But, is he/she able to meet daily tasks, recreational activities, and unforeseen emergencies with vigor and enthusiasm and without undue fatigue? Is he/she making adequate use of the musculoskeletal and cardiopulmonary systems? Lack of encouragement to exercise in early life is reflected in the National Adult Physical Fitness Survey conducted by the President's Council on Physical Fitness in 1972. This study showed that 45% of all adult Americans do not engage in physical activity for the purpose of exercise. However, 63% of these nonexercisers said they believed they had enough exercise; only 57% of those who exercised regularly thought they did enough of it. Normal growth and development in infancy should assure physical fitness for ordinary and even strenuous physical tasks because of innate, powerful drives toward functional development at this period of life. The infant who naturally strives for motor fitness can be on the way to a lifetime of improving physical fitness. The preschool child who characteristically uses his large muscles during many hours of the day is continuing a self-imposed program of physical fitness.