New Guidelines on Kids' Drowning Prevention

American Academy of Pediatrics Says Children as Young as 1 May Get Swimming Lessons

Medically Reviewed by Laura J. Martin, MD on May 24, 2010
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May 24, 2010 -- The American Academy of Pediatrics (AAP) has issued new policy guidelines calling for children as young as age 1 to receive swimming lessons, depending on how often they are exposed to water and judgments made by parents about their maturity.

The AAP says its existing recommendation had been that most children age 4 and older should learn to swim, but now is "more open" to the idea of classes for younger kids.

The pediatric group says that in the past, it advised against swimming lessons for children 1-3 because there was little evidence that lessons prevented drowning or resulted in better swimming skills.

Also, the AAP says it has been concerned about whether parents would remain vigilant enough about supervising children who had learned some swimming skills. But it now says new evidence shows that kids age 1-4 may be less likely to drown if they have formal swimming lessons.

The studies showing this are small and don't define what types of lessons might work best, so the AAP says it is not recommending mandatory swimming lessons for all children 4 and younger.

Age for Swimming Lessons: Parents Make the Call

The new guidance calls for parents to decide whether to enroll a child in swimming lessons based on the youngster's frequency of exposure to water, physical abilities, emotional development, and health concerns related to pool-water infections and chemicals.

"Not every child will be ready to learn to swim at the same age," says Jeffrey Weiss, MD, FAAP, lead author of the policy statement. "To protect their children, parents need to think about layers of protection."

Still, the statement cites a report from the Eunice Kennedy Shriver National Institute of Child Health and Human Development that swimming lessons do not increase the risk of drowning in 1- to 4-year-olds and may reduce drowning risk in that age group. A study from China also showed a benefit of formal swimming instruction for the same age group.

One reason for its alteration of previous guidelines, the AAP says, is the emergence in the past few years of new drowning risks, such as inflatable pools that are large, inexpensive, and portable.

Drowning rates have fallen from 2.68 per 100,000 in 1985 to 1.32 per 100,000 in 2006, the AAP says. Still, drowning is the second leading cause of death for children ages 1-19, claiming 1,100 young lives in 2006.

According to the AAP, teenagers and toddlers are at greatest risk. "From 2000 to 2006, the highest death rates were seen in white boys 0 to 4 years of age and black male adolescents 15 to 19 years of age," the policy statement says. "In 2008, approximately 3,800 children younger than 20 years visited a hospital emergency department for a non-fatal drowning event, and more than 60% of those children were hospitalized."

No matter what, children cannot be made "drown-proof," Weiss says, so all children need to learn to swim and should be supervised very closely by parents and other adults when around water.

Pools Need Fences

Also, adults who supervise kids should know how to perform cardiopulmonary resuscitation (CPR), the AAP says. In addition, all pools should be surrounded by a four-sided fence, isolating it from houses. Taking that step alone can cut downing risk in half, the AAP says.

But some laws governing pool fencing have "dangerous" loopholes, according to the AAP.

Large, inflatable above-ground pools can hold thousands of gallons of water, sometimes may require filtration systems, and often are left filled for weeks, as long as weather is warm.

Because such pools are portable, they often are exempt from local building codes that require fences around pools, AAP says.

The Consumer Product Safety Commission reported 47 deaths of children related to inflatable pools between 2004 and 2006.

"Because some of these pools have soft sides, it is very easy for a child to lean over and fall head first into the water," Weiss says. "These pools pose a constant danger."

While kids younger than age 4 might be ready for swimming lessons, the AAP says it still does not recommend formal water safety programs for tots under age 1. It says in a news release that the water-survival skills of infants are interesting to watch and make interesting videos for the Internet, but that there is no scientific evidence they are effective in preventing drowning.

In addition to considering lessons, the updated policy also outlines dangers of bodily entrapment and hair entanglement in a pool or spa drain, and points out that special drain covers and devices can reduce risk.

Drowning Prevention Tips for Parents

The AAP says parents should:

  • Never, even for a moment, leave small kids alone or in the care of another young child, in bathtubs, pools, spas or wading pools, or near irrigation ditches or standing water. Children also should not be left alone in bathrooms to avoid drowning in toilets.
  • Closely supervise kids in and around water. An adult should be within arm's length, and when watching older children, should stay focused and vigilant.
  • Make sure kids being taken care of outside the home are safe, asking caregivers about exposure to water and the ratio of adults to kids.
  • Install a four-sided fence at least 4 feet high to limit access. It should be hard to climb, not chain-link, and have a self-latching, self-closing gate. Families might want to consider rigid pool covers and alarm systems for their pools.
  • Learn CPR and make sure caregivers know it, too.
  • Do not use air-filled swimming aids, such as arm bands that inflate, in place of life jackets.
  • Make sure kids wear life jackets when in boats, and even at the edge of water, on a pier, or riverbank.
  • Be aware of the depth of water your children are playing in and be alert for any underwater hazards before letting kids jump in. Make sure kids who do jump into water do so feet first, never head first.
  • Choose swimming areas with lifeguards.
  • Make sure children and their supervisors are aware of what to do in rip currents, which is to swim parallel to the shore until out of the current before returning to shore.
  • Counsel teenagers about the increased risk of drowning when alcohol is involved.
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News release, American Academy of Pediatrics.

Weiss, J. Pediatrics, July 2010; vol 126.

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