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PEDIATRICS Vol. 105 No. 4 April 2000, pp. 868-870
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ABSTRACT |
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Abstract
Recommendation
References
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Infant and toddler aquatic programs provide an opportunity to introduce young children to the joy and risks of being in or around water. Generally, children are not developmentally ready for swimming lessons until after their fourth birthday. Aquatic programs for infants and toddlers have not been shown to decrease the risk of drowning, and parents should not feel secure that their child is safe in water or safe from drowning after participating in such programs. Young children should receive constant, close supervision by an adult while in and around water.
Drowning is a leading cause of unintentional injury and
death in the pediatric age group. In the United States, drowning rates are the highest among children ages 1 through 2 years. In Arizona, California, Florida, and Texas, drowning is the leading cause of death
in this age group.1 Other reported medical risks to
infants and toddlers that involve being in water include
hypothermia,2,3 water intoxication,4-6 and
the spread of communicable diseases.7 Serious consequences
from these medical conditions are rare and can generally be reduced by
following existing guidelines published by the American Red
Cross8 and the YMCA.9 The policy statement
published in 1993 by the American Academy of Pediatrics (AAP) entitled
"Drowning in Infants, Children, and Adolescents"10
also provides an excellent review of the subject. This AAP policy
statement on infant swimming programs is an update of the 1985 policy.11
Infant and toddler aquatic programs are popular throughout the United
States. An estimated 5 to 10 million infants and preschool children
participate in formal aquatic instruction programs. Infant and
preschool programs have been developed by such organizations as the
American Red Cross8 and the YMCA.9,12 These
programs, which focus on aquatic adjustment and swimming readiness
skills, may also include water safety instruction for parents and
guardians. They provide enjoyment for parents and children but were not
designed to teach children to become accomplished swimmers or to
survive independently in the water. Other infant/toddler aquatic
programs, however, attempt to develop water survival skills.
Regardless of the program design or focus, infant and toddler aquatic
programs are unable to ensure that children will understand water
hazards, use appropriate avoidance strategies, or attain program safety
goals. Currently, no data are available to determine if infant and
toddler aquatic programs increase or decrease the likelihood of
drowning. Programs that claim to make children safe in water or safe
from drowning are misrepresenting what is possible and are giving
parents a false sense of security about their child's safety in the
water.
Swimming skills (ie, the ability to perform standard swimming strokes)
should be distinguished from water safety skills (ie, survival
flotation, energy conservation "swimming," or poolside safety
behavior). Without specific training, children can perform rudimentary
swimming movements in the water sometime around their first
birthday.13 The types of swimming movements a young child
first demonstrates are not traditional strokes, such as the front
crawl, but are more basic movements similar to the dog paddle. The
optimum time to master more complex skills of swimming has not been
thoroughly researched and has not been determined. A recent study by
Blanksby et al14 showed that swimming skills can be
acquired more readily once motor development has reached the 5-year-old
level. Although some children may acquire swimming skills earlier,
Parker and Blanksby15 found that children younger than 4 years require longer instructional periods to learn skills and are
limited by their neuromuscular capacity. Therefore, having children
begin swimming lessons at an earlier age does not translate to a more
rapid mastery of aquatic skills or a higher level of swimming
proficiency compared with those taking lessons at a later
age.
The effects of training on the acquisition of water survival skills in
young children have been studied by Asher et al16 In a
population of children averaging 34 months of age, water survival
skills were enhanced after a training program. Safety training,
however, did not result in a significant increase in the poolside
safety skills of these children. The correlation between measurable
safety skills and risk of drowning has not been established.
For any water safety or swimming class, children learn better if they
are developmentally ready, properly motivated, positively reinforced,
and if the experience is enjoyable. When instruction attempts to
optimize learning by reducing fear of water, children may unwittingly
be encouraged to enter the water without supervision.
Regardless of an infant's or toddler's apparent level of comfort and
competence in or around water, constant close supervision by an adult
is necessary to prevent drowning and near-drowning. Even a brief lapse
in supervision can have tragic results.17-20 The concept
of "touch supervision" has been advocated, which requires the
caregiver to be within an arm's reach or able to touch the swimmer at
all times.
Until more clear-cut scientific evidence exists on the effects of
infant and toddler aquatic programs, the AAP recommends the following:
RECOMMENDATIONS
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Abstract
Recommendation
References
COMMITTEE ON SPORTS MEDICINE AND FITNESS,
1999-2000
Steven J. Anderson, MD, Chairperson
Bernard A. Griesemer, MD
Miriam D. Johnson, MD
Thomas J. Martin, MD
Larry G. McLain, MD
Thomas W. Rowland, MD
Eric Small, MD
LIAISON REPRESENTATIVES
Claire LeBlanc, MD Canadian Paediatric Society
Robert Malina, PhD Institute for the Study of Youth Sports
Carl Krein, AT, PT National Athletic Trainers Association
Judith C. Young, PhD National Association for Sport and Physical
Education
SECTION LIAISONS
Frederick E. Reed, MD Section on Orthopaedics
Reginald L. Washington, MD Section on Cardiology
CONSULTANT
Stephen Bolduc, MD
COMMITTEE ON INJURY AND POISON PREVENTION,
1999-2000
Marilyn J. Bull, MD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD
LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH National Institute of Child Health
and Human Development
Stephanie Bryn, MPH Health Resources and Service
Administration/Maternal and Child Health Bureau
Cheryl Neverman, MS National Highway Traffic Safety Administration
Richard A. Schieber, MD, MPH Centers for Disease Control and
Prevention
Richard Stanwick, MD Canadian Paediatric Society
Deborah Tinsworth US Consumer Product Safety Commission
William P. Tully, MD Pediatric Orthopaedic Society of North America
SECTION LIAISONS
Robert R. Tanz, MD Section on Injury and Poison Prevention
Victor Garcia, MD Section on Surgery
CONSULTANTS
Murray L. Katcher, MD, PhD
Former COIPP Chairperson
Barbara Smith, MD
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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AAP, American Academy of Pediatrics.
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REFERENCES |
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Abstract
Recommendation
References
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Statement of reaffirmation:
The following policy statement has been revised:
This article has been cited by other articles:
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  J. D. Reich Criticism of Infant Swimming Practice Is Political, Not Scientific Pediatrics, October 1, 2007; 120(4): 926 - 927. [Full Text] [PDF]
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A. Bernard, S. Carbonnelle, X. Dumont, and M. Nickmilder Infant Swimming Practice, Pulmonary Epithelium Integrity, and the Risk of Allergic and Respiratory Diseases Later in Childhood Pediatrics, June 1, 2007; 119(6): 1095 - 1103. [Abstract] [Full Text] [PDF]
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 A Bernard and M Nickmilder Respiratory health and baby swimming Arch. Dis. Child., July 1, 2006; 91(7): 620 - 621. [Full Text] [PDF]
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R. A. Brenner and Committee on Injury, Violence, and Poison Preventi Prevention of Drowning in Infants, Children, and Adolescents Pediatrics, August 1, 2003; 112(2): 440 - 445. [Abstract] [Full Text] [PDF]
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 E. Weir Drowning in Canada Can. Med. Assoc. J., June 1, 2000; 162(13): 1867 - 1867. [Full Text] [PDF]
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