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The increasing emergence of legislation providing for minors' consent for health care furnishes a range of basic medical, legal, and social issues which require the thoughtful consideration of physicians caring for youth. The legislative provisions referred to account for a variety of consent situations ranging from the care of a specific illness or disorder to the dramatic lowering of the age for which consent for health care can be given. The ultimate conflict in the matter of minor's consent is between the basic rights and responsibilities of parents concerning their children and the emergence of the concept that youths have the right to make decisions relating to their bodies and their care. When the preservation of privacy and confidentiality affects the utilization of health care by youth, the conflict must be resolved. Not only have state legislatures provided varying opportunities to resolve some of these issues, but also two major health organizations concerned with the health of youth have provided model acts which would serve as a basis for enabling young people to consent for confidential, comprehensive health care. In recent years society has demonstrated a tendency to permit young people to determine a variety of aspects of their own affairs well before the traditional age of majority. In regard to health decisions, a number of situations have emerged in which the rights of youths deserve consideration. These include circumstances in which the person might avoid health care if the parents have to be informed, when a communication breakdown between the young person and the parents has taken place, if a need for emergency care occurs when parents cannot be reached, or when young people are living away from home in an adult life style. Legislative responses to the sociohealth concerns affecting youth do not take a moral or judgmental position, nor do they infer a lessening of the importance of family integrity. They do respond to a number of reality health matters with high incidence which have emerged, particularly in the past decade. These laws do not require physicians to treat young people on their own consent, nor do they forbid physicians from informing parents if this is considered in the best interest of the patient. Furthermore, it is important for the physician to persuade youths to involve their parents and gain their support and understanding. Minors' consent can serve to restore interrupted communication between young people and their families. The appearance and evolution of the "emancipated minor" and the "mature minor" concepts is recognition of the capacity of the adolescent to determine his own affairs and give an informed consent. The age at which human beings reach maturity is variable, and competent decision making is not assured by arrival at a certain chronological age.

As a result of the sharp rise in venereal disease during the past decade, which seriously threatens the health of our young people, pediatricians must become actively involved: 1. in the prompt identification, treatment, and epidemiologic control of venereal disease in young people and newborn infants; 2. in developing and promoting social legislation related to the treatment of minors; 3. in encouraging and participating in effective educational programs for youth on venereal disease. A heightened alertness to the possibility of venereal disease is required by every physician.

Young people who find themselves in juvenile court facilities constitute a group who traditionally have displayed a high incidence of health problems. Many have had inadequate care in the past, and enter with preexisting medical and dental conditions. Whether or not they are in good physical health, they often are handicapped in the area of mental health. The conditions which necessitate removing them from their homes and placing them in institutions may aggravate, or even cause, physical and mental health problems. When society undertakes to remove children and youth from their homes and place them in institutions away from the care of their parents, it assumes certain obligations. Among these obligations is care of their physical and mental health. Health programs in juvenile court facilities must be broad and comprehensive and must go beyond the mere provision of medical care. The extent of the health care which should be offered to an individual will depend on the length of time he is in the institution. But, every institution which confines juveniles should have a health program designed to protect and promote the physical and mental well-being of residents, to discover those in need of short-term or long-term medical and dental treatment, and to contribute to their rehabilitation by appropriate diagnosis and treatment and provision of continuity of care following release. The standards given here are designed to attain these goals. ADMINISTRATIVE STRUCTURE OF THE HEALTH PROGRAM Health Council 1. Each institution should have a multidisciplinary health council to set the policies of the health program. 2. The council may be organized within the institution or by the authority which operates the institution.

Interviews with 63 male prostitutes were carried out in San Francisco and Seattle. Information is presented regarding background and present mode of operation within the two cities. Data presented are derived solely from interviews conducted in the natural setting of the street corner, bar, or automobile. An attempt is made to describe this group of young males as thoroughly as possible in order to suggest some methods of rehabilitation. Some of the more outstanding characteristics of the group were their limited education, high mobility, unstable home environment, and lack of social and vocational skills. Although most were unemployed when interviewed, they expressed interest in finding work, and a number were given assistance in obtaining employment. While the authors feel justified in presenting this information on the 63 boys interviewed, extensive generalization to a larger population would be unwarranted and further research is indicated to confirm findings of this preliminary study.

Whereas, certain minors are not obtaining adequate medical, dental, or other health care due to current legal and medical obstacles, Whereas, providers of medical, dental, and other health care are now vulnerable to legal action for giving care to minors, Whereas, there is a need for coordination, stimulation, and support of access to medical, dental, and other health care for certain minors in need of such care without violating the rights of parents to protect and promote their minors' health, Be It Enacted by the Legislature of the State of-----,as follows: Section 1. For the purposes of this act: (1) "Minor" means any person under the age of majority as defined by the State statute or under 18 years of age, whichever is lower; (2) "Health Professional" means state licensed physician, psychologist, dentist, osteopathic physician, nurse, and other licensed health practitioner; (3) "Health Services" means health services specified by the state, appropriately delivered by different health professionals including examination, preventive and curative treatment, operation, hospilization (admission or discharge), giving or receiving blood and blood derivatives, receiving organ transplantation, pledging donation of organs after death, the use of anesthetics, and receiving contraceptive advice and devices; (4) The masculine shall include the feminine. Section 2. Any person who reaches the age of majority or 18 years of age or is on active duty with or has served in any branch of the Armed Forces of the United States shall be considered an adult in so far as the consent for health services is concerned.

The pediatrician can be useful to the young person with a drug problem if he: (1) is aware of the different motivations for drug abuse by adolescents and how to approach them, (2) recognizes the need for confidentiality, (3) provides factual information in a non-authoritarian manner and listens and counsels as indicated, and (4) manipulates the environment-to relieve school and family pressures and to help youngsters find better challenges. Drug abuse in children and adolescents is a major source of concern to parents, educators, law enforcement agencies, and physicians. For the pediatrician as well as the others, a challenge exists to find more appropriate ways of help for young people who turn to drug abuse for the answer that is not there.

The diagnosis, treatment and prognosis of minor motor epilepsy, based on study of 698 children, are discussed; 622 were followed for intervals ranging from 3 to 22 years. Minor motor seizures begin most often between 3 and 12 months of age. Brain damage is prominent in the general clinical manifestations of patients with minor motor epilepsy. Hypsarhythmic abnormalities are present in the electroencephalograms of most patients. Minor motor seizures rarely recur after 5 or 6 years of age. These spells are exceedingly difficult to control with anticonvulsant drugs. A ketogenic diet is the most effective therapy. The most serious aspect of minor motor epilepsy is the associated mental retardation. Presumptive etiologic factors are discussed.

Summary Interviews were obtained with members of the families of 669 epileptic subjects with 3,361 close relatives, and 470 control patients with 2,858 close relatives. A small but significant familial aggregation of idiopathic major motor epilepsy was demonstrated. This aggregation appeared to vary with the age of the proband at onset of epilepsy and was highest when the proband's epilepsy started between the ages of 0 and 31/2 years and between 91/2 and 151/2 years. No familial aggregation could be demonstrated when the age at onset was over 151/2 years, or in other types of epilepsy. Simple febrile convulsions were not included in the study. Hereditary transmission of epilepsy could not be demonstrated, but it could not be ruled out. Familial aggregation of idiopathic major motor epilepsy may be due to familial aggregation of perinatal brain injury, to inheritance, or to a combination of these factors. Further studies are needed to clarify this. Risk tables are presented, showing the chances of relatives of patients with idiopathic major motor epilepsy of developing epilepsy. The highest risk was found to occur in the close relatives of probands who had developed major motor epilepsy before 31/2 years of age: 7.6 per cent of these relatives may be expected to develop major motor seizures by 191/2 years of age, and 9.4 per cent by 391/2 years of age. Comparable control risks were 1.4 and 2.3 per cent.

CONVENTIONAL electrocardiographic electrodes are ill-adapted to use on small premature infants. The size of these electrodes and the necessity of using rubber straps to attach them make it difficult to obtain adequate electrical contact without the risk of injury to the baby. Furthermore, such electrodes cause sufficient discomfort so that a vigorous infant rarely lies quietly. The "infant-size" electrodes are scarcely better on the smaller babies. We have had no success using suction type electrodes. Lepeschkin in 1951 described a self-retaining precordial electrode designed for use on adults. The following apparatus is constructed to permit the use of Lepeschkin electrodes for all leads on extremely small infants.

This program shows again the price paid for fragmented health services. The provision of screening teams outside of normal channels of health care resulted in the discovery of many health defects, but in the treatment of less than half of them. Several ways might be found to improve the program. At the present time we believe that an effective school health assessment can be made without physical examinations. Instead, if it is felt that heart disease should be detected in school, heart-sound screening could be added to the test battery. Teacher observation should be utilized by emphasizing the teacher-nurse conferences. This would result in referral not only of physical abnormalities, but of children with behavioral symptoms, and children with such conditions as hyperactivity and dyslexia. Such a procedure has been advocated for nearly 30 years. It would leave unsuspected hernias, which are rare, and inapparent otitis without pain, fever, or hearing loss which is probably of little significance, as the major abnormalities liable to be overlooked in health assessment. The program described here would have been far more effective had nursing time been used in the follow-up of health defects rather than in physical examinations. For instance, two of the four nurses on the screening teams might have worked with community nurses and school personnel to reach the parents. In our opinion, abandoning physical examinations and redirecting nursing time into coordination and follow-up would result in better health care for the children in the program.

Dr. Gilbert has pointed to the outstanding considerations in health care for migrants, although we must disagree with his interpretation of our report. We did not say or imply that "there is no serious health problem among migrant children" and we do not believe that services for this group are adequate. Our point, which I welcome the chance to reemphasize, is simply that concentration on case-finding doesn't cure anyone unless it is linked to adequate follow-up.

Pediatricians have long interested themselves in the health of juvenile delinquents. The Academy first appointed a Committee on Juvenile Delinquency in 1955. Although this Committee has changed its title to the Committee on Youth and has expanded its role to include other problems and concerns of young people, it still concerns itself with the health supervision of youth in detention facilities. It has now developed, with the endorsement of the National Council of Juvenile Court Judges, written standards for health care provided in juvenile court institutions.1 Juvenile delinquents come largely from low income families, and often from families with serious social problems.

In a previous statement approved by the Executive Board of the American Academy of Pediatrics, and subsequently by the House of Delegates of the American Medical Association, the American College of Obstetricians and Gynecologists emphasized the magnitude of the problem of teenage pregnancy and the responsibilities of professionals involved in the care of these young people. Rapid changes in contemporary attitudes and in legislation have caused many physicians and their patients to consider abortion as an acceptable solution to an unwanted pregnancy in adolescent girls. These changes place a heavy responsibility on pediatricians and other physicians caring for adolescents, particularly in regard to their special need for compassionate and considerate understanding. Although the American Academy of Pediatrics prefers neither to sanction nor to forbid the use of abortion to terminate an unwanted pregnancy in the teen-age girl, it does have the responsibility to insist that physicians considering this recourse provide for appropriate counseling and support for these adolescent girls and other involved persons, including the young fathers. In circumstances where the pediatrician is unable to provide adequate counseling support, he should act as the pivotal person in arranging for a social worker, pastor, or other experienced counselor to conduct this essential of care, both before and after the procedure. Consistent with his accredited role in preventive medicine, the pediatrician must make certain that adequate information and sex counseling are available to his teenage patients. Contraceptive advice and prescription for the sexually active teenage girl should be accompanied by investigation and alteration of contributing issues wherever possible.

In October 1970, the Academy identified itself with those who favored Separating marijuana from the group of drugs subject to stringent narcotic laws. It recommended that individuals who were found to be in possession of the drug for personal use, or were present where the drug was being used, should be charged with a misdemeanor rather than a felony.1 Subsequently, the Committee on Drugs in a statement on drug abuse legislation noted its concern with marijuana.2 This position is based on the fact that marijuana is clearly not a narcotic and does not appear to have a potential for physical dependence. It should not be construed, however, as favoring the legalization of marijuana. A decision in this regard must await the development of further research on the properties of the drug. The potency of marijuana has not been standardized and may vary widely. Furthermore, anecdotal accounts exist of the adulteration of marijuana with other chemical agents to produce a more profound effect. It has therefore been difficult to determine with precision the effects of marijuana as it is commonly used. The limited research findings that are currently available would not appear to indicate any significant harmful physical effects from the smoking by humans of moderate amounts of plain marijuana. The recent report from the Department of Health, Education and Welfare3 states that "although the state of intoxication is frequently vivid as described by the (marijuana) user, an observer may see little change from a normal state. Mild states of intoxication often go completely undetected. Physiological changes are notably minimal."

A survey of community genetics programs in 1966 showed that 15 states had such programs in their state health departments. A composite listing is presented of genetics services which are currently being provided to communities by these programs. As new knowledge about genetics is accumulated, health workers of all types will need training in this field.

Problems relating to human reproduction are among the critical issues of our time, and it is appropriate that pediatricians contribute to the solution of these problems. The changing dimensions of comprehensive pediatric care, more specifically the significant numbers of pregnancies being reported in young persons, support this position. For example, national statistics show that 44% of all pregnancies occur in persons under 20, and one out of four mothers on Aid to Families with Dependent Children in New York is pregnant before 16. At least four roles can be identified for the pediatrician: 1. Genetic counseling: the pediatrician has already become proficient in giving knowledge to parents of the incidence of inborn errors of metabolism, chromosomal abnormalities, and other problems associated with genetic inheritance patterns. 2. Sex education: he often provides sex education to individual patients, families, and parents, in addition to teaching groups in his own practice and in schools, churches, or youth organizations. 3. Family planning and pregnancy counseling: he may provide assistance in these areas in behalf of the parents or adolescents. This assistance may involve a wide range of clinical advice and treatment, including the concept of spacing (rhythm method), contraceptive devices, or oral medication, whatever is considered most suitable for the individual. All alternatives for dealing with an unwanted pregnancy should be seriously discussed with the teenage girl and the other persons involved, including the parents if feasible. The pediatrician is in a unique position by the nature of his close association and relationship with the adolescent patient to provide this important personal service.

IN 1959, Usher1and Reardon2reported that the mortality rate in newborn infants with the idiopathic respiratory distress syndrome could be lowered by intravenous therapy with glucose solutions containing either bicarbonate or saline. The present study was undertaken in an attempt to better define the role that glucose administration plays in the survival of these distressed newborns. Method The study was conducted at the Kaiser Foundation Hospital in San Francisco. Infants available for the study were those born in the hospital between Feb 1, 1960 and Feb 1, 1962. Any infant who developed persistent respiratory distress with a Silverman retraction score3of 2 or more in the first 36 hours of life, was eligible for inclusion in the study. Of the 113 infants fulfilling this requirement, 12 were excluded because the infants' pediatricians elected not to include them in the study. Three infants were excluded from the