AMERICAN ACADEMY OF PEDIATRICS
Committee on Sports Medicine and Fitness and Committee on Injury and Poison Prevention
ABSTRACT. 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.' Other reported medical risks to infants and
toddlers that involve being in water include hypothermia water intoxication, and the
spread of communicable diseases. Serious consequences from these medical conditions are
rare and can generally be reduced by following existing guidelines published by the
American Red Cross and the YMCA. The policy statement published in 1993 by the American
Academy of Pediatrics (AAP) entitled "Drowning in Infants, Children, and
Adolescents" also provides an excellent review of the subject. This AAP policy
statement on infant swimming programs is an update of the 1985 policy."
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 Cross' and the YMCA . 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.
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.
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 (as, the ability to perform standard swimming strokes)
should be distinguished from water safety skills (as, 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." 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 a1 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 Blanksby 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 a1 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. 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.
RECOMMENDATIONS Until more clear-cut scientific evidence exists on the effects of
infant and toddler aquatic programs, the AAP recommends the following:
1. Children are generally not developmentally ready for formal swimming
lessons until after their fourth birthday.
2. Aquatic programs for infants and toddlers should not be promoted as
a way to decrease the risk of drowning.
3. Parents should not feel secure that their child is safe in water or
safe from drowning after participation in such programs.
4. Whenever infants and toddlers are in or around water, an adult
should be within an arm's length, providing "touch supervision."
5. All aquatic programs should include information on the cognitive and
motor limitations of infants and toddlers, the inherent risks of water, the strategies for
prevention of drowning, and the role of adults in supervising and monitoring the safety of
children in and around water.
6. Hypothermia, water intoxication, and communicable diseases can be
prevented by following existing medical guidelines and do not preclude infants and
toddlers from participating in otherwise appropriate aquatic experience programs.
(Keep small infants exposure to cold water very short until their body
is larger after 18months old. Take their temperature after swimming and be sure it does
not go below 97 degrees.)
7. Pediatricians and parents should support data collection, drowning
prevention research, and legislation aimed at reducing the risk of drowning in young
children in and around water.
PEDIATRICS (ISSN 0031 4005). Copyright 2000 by the American Academy of
Pediatrics.
