Swimming lessons for infants and toddlers

Paediatr Child Health 2003;8(2):113-4
Reference No. IP03-01

Reaffirmed February 2008

Parent handout: Swimming and water safety for young children

Index of position statements from the Injury Prevention Committee

Drowning is the second leading cause of unintentional injury death in Canadian children one to four years of age, accounting for more than one-fifth of deaths in this age group (1,2). Hospitalization rates for near-drowning peak in the toddler age group, with a five-fold increased risk compared with older children (2). Infant and toddler drownings tend to occur in or around the home, with infants mostly in bathtubs, and toddlers falling into swimming pools (3,4).

Swimming programs for infants as young as several months of age are widely available in Canada. These programs are designed to introduce young children to water, build water confidence, and teach water safety to parents and guardians. Few studies have examined readiness for swimming lessons in this age group. Parker and Blanksby (5) reported that children’s earliest mastery of water confidence and basic aquatic locomotive skills is four years of age, despite the age at which lessons commence. Blanksby et al (6) reported that children achieved the skills necessary to perform the front crawl at 5.5 years of age, regardless of whether lessons began at two, three or four years of age.

There is evidence that swimming lessons improve swimming ability and deck behaviour in young children (two to four years of age); however, the long term maintenance of these skills has not been reported (7,8). There is no evidence that swimming lessons prevent drowning or near drowning in this age group. Although it may be possible to teach young infants basic motor skills for 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’. Active adult supervision and four-sided pool fencing are the best strategies against drowning in this age group (9-11). In particular, pool alarms are not effective and may give parents a false sense of security. Hazards of swimming lessons for young children other than drowning include water intoxication with hyponatremia and seizures, hypothermia, and various infectious diseases including otitis externa (12-19).

Based on the current research evidence on the effectiveness of infant and toddler aquatic programs, the Canadian Paediatric Society recommends that:

• Swimming programs for infants and toddlers less than four years of age should not be promoted as being an effective drowning prevention strategy.

• Children less than four years of age do not have the developmental ability to master water survival skills and swim independently. Aquatic activities and swimming programs for these children should focus on building confidence and educating parents regarding water safety.

• Swimming instruction should be carried out by trained instructors in pools that comply with current standards for design, maintenance, operation, and infection control (to reduce the risk of hepatitis A, gastroenteritis, skin infections, etc.).

• Residential pools should be fenced on all four sides, and must include a self-closing, self-latching gate. Check with the local municipality for other requirements, such as height and type of fencing.

• Constant arms-length adult supervision is recommended for toddlers and infants near water (pools, bathtubs and natural bodies of water). Infants placed in water must be held by an adult at all times.

• Government-approved personal flotation devices (PFDs) should be used for all young children and those who cannot swim. PFDs are not a substitute for supervision.

• Parents and pool owners should be encouraged to receive first aid and cardiopulmonary resuscitation (CPR) training, and to maintain an emergency action plan.

References

1. Health Canada, Population and Public Health Branch. Canadian injury data: Mortality and hospitalizations 1997-1998. Ottawa: Health Canada, 1999. <http://www.hc-sc.gc.ca/pphb-dgspsp/injury-bles/cid98-dbc98/index.html> (Version current at January 7, 2003).

2. Health Canada. For the Safety of Canadian Children and Youth: From Injury Data to Preventive Measures. Ottawa: Health Canada, 1997.

3. Canadian Red Cross Society. National Drowning Report: An Analysis of Drownings and Other Water-related Injury Fatalities in Canada for 1997. Montreal: Canadian Red Cross Society, 1999.

4. Canadian Red Cross Society. National Drowning Report: An Analysis of Drownings and Other Water-related Injury Fatalities in Canada for 1998. Montreal: Canadian Red Cross Society, 2000.

5. Parker HE, Blanksby BA. Starting age and aquatic skill learning in young children: Mastery of prerequisite water confidence and basic aquatic locomotion skills. Aust J Sci Med Sport 1997;29:83-7.

6. Blanksby BA, Parker HE, Bradley S, Ong V. Children’s readiness for learning front crawl swimming. Aust J Sci Med Sport 1995;27:34-7.

7. Asher KN. Water safety training as a potential means of reducing risk of young children’s drowning. Injury Prevention 1995;1:228-33.

8. Erbaugh SJ. Effects of aquatic training on swimming skill development of preschool children. Percept Mot Skills 1986;62:439-46.

9. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Drowning in infants, children, and adolescents. Pediatrics 1993;92:292-4.

10. Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database Syst Rev 2000;2:CD0001047.

11. American Academy of Pediatrics, Committee on Sports Medicine and Fitness and Committee on Injury and Poison Prevention. Swimming Programs for Infants and Toddlers. Pediatrics 2000;105:868-70.

12. Kroop RM, Schwartz JF. Water intoxication from swimming. J Pediatr 1982;101:947-8.

13. Wright M, deSilva P, Sinha S. Hyponatremia in children. BMJ 1992;305:51-2.

14. Bennett HJ, Wagner T, Fields A. Acute hyponatremia and seizures in an infant after a swimming lesson. Pediatrics 1983;72:125-7.

15. O’Connor, RE. Water intoxication with seizures. Ann Emerg Med 1985;14:71-3.

16. Goldberg GN, Lightner ES, Morgan W, Kemberling S. Infantile water intoxication after a swimming lesson. Pediatrics 1982;70:599-600.

17. Mahoney FJ, Farley TA, Kelso KY, Wilson SA. An outbreak of hepatitis A associated with swimming in a public pool. J Infect Dis 1992;165:613-8.

18. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Shigellosis outbreak associated with an unchlorinated fill-and-drain wading pool – Iowa, 2001. JAMA 2001;286:1964-5.

19. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Protracted outbreaks of cryptosporidiosis associated with swimming pool use – Ohio and Nebraska, 2000. JAMA 2001;285:2967-9.

Members: Drs Claire LeBlanc, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; John LeBlanc, IWK Health Centre, Halifax, Nova Scotia; Bich Hong Nguyen, Sainte-Justine Hospital, Outremont, Quebec; Richard Stanwick, Capital Health Region, Victoria, British Columbia; Lynne Warda, University of Manitoba, Winnipeg, Manitoba (chair); David Wong, Prince County Hospital, Summerside, Prince Edward Island (director responsible)
Consultant: Dr Milton Tenenbein, University of Manitoba, Winnipeg, Manitoba
Liaisons: Mr Yves Fortin, Ottawa, Ontario (Product Safety Branch, Health Canada); Ms Sonya Corkum, Toronto, Ontario (Safe Kids Canada)
Principal Authors: Drs Bich Hong Nguyen, Sainte-Justine Hospital, Outremont, Quebec; Lynne Warda, University of Manitoba, Winnipeg, Manitoba