The American Academy of Pediatricians (AAP) has issued a recommendation that kids stay off of trampolines. They cited the exercise units as being responsible for over 100,000 injuries a year, some of which include serious life threatening spinal injuries. The new statement updates an AAP recommendation from 1999 that caused trampoline manufacturers to add safety features like padding and nets in an attempt to reduce risks. Since then, while overall injuries have been dropping, the number of trampolines in use have dropped as well, meaning the injury rate has remained constant despite the new safety features. While the majority of injuries to children in trampoline accidents cited were ankle sprains and fractures, the AAP also noted that one in 200 trampoline injuries lead to permanent neurological damage, often caused by botched somersaults or flips. The recreational use of trampolines was "strongly discouraged" by the pediatricians' group, but parents who are unwilling to stop their kids from using trampolines were offered a number of tips to make the activity safer, including using the mat one at a time, maintaining effective padding around springs and frame, placing the trampoline on level ground, avoiding somersaults and flips and actively supervising kids. Trampoline manufacturers meanwhile, issued a statement that trampolines are safer for children by hours of use, than activities like skateboarding, climbing trees or swings.