head to the beach or pool this Memorial Day, the American Academy of
Pediatrics (AAP) has updated guidance on water safety and drowning
prevention. In its updated policy, the AAP has revised its guidance on
swimming lessons and highlights new drowning risks – including large,
inexpensive, portable and inflatable pools – that have emerged in the
past few years.
drowning rates have fallen steadily from 2.68 per 100,000 in 1985 to
1.32 per 100,000 in 2006. But drowning continues to be the second
leading cause of death for children ages 1 to 19, claiming the lives of
roughly 1,100 children in 2006. Toddlers and teenaged boys are at
their children, parents need to think about layers of protection,” said
Jeffrey Weiss, MD, FAAP, lead author of the policy statement and technical report, which will be published in the July print issue of Pediatrics and released early online May 24.
to learn to swim,” Dr. Weiss said. “But even advanced swimming skills
cannot ‘drown-proof’ a child of any age. Parents must also closely
supervise their children around water and know how to perform CPR. A
four-sided fence around the pool is essential.”
A fence that
completely surrounds the pool – isolating it from the house – can cut
drowning risk in half. Unfortunately, laws regarding pool fencing may
have dangerous loopholes. Large, inflatable above-ground pools can
contain thousands of gallons of water and may even require filtration
equipment, so they are left filled for weeks at a time. But because
they are considered “portable,” these pools often are exempt from
local building codes requiring pool fencing. From 2004 to 2006, the
Consumer Product Safety Commission (CPSC) reported 47 deaths of
children related to inflatable pools.
“Because some of
these pools have soft sides, it is very easy for a child to lean over
and fall headfirst into the water,” Dr. Weiss said. “These pools pose a
In the new
policy, the AAP reinforces its existing recommendation that most
children age 4 and older should learn to swim, but the AAP is now more
open toward classes for younger children. In the past, the AAP
advised against swimming lessons for children ages 1 to 3 because
there was little evidence that lessons prevented drowning or resulted
in better swim skills, and there was a concern parents would become
less vigilant about supervising a child who had learned some swimming
But new evidence
shows that children ages 1 to 4 may be less likely to drown if they
have had formal swimming instruction. The studies are small, and they
don’t define what type of lessons work best, so the AAP is not
recommending mandatory swim lessons for all children ages 1 to 4 at
this time. Instead, the new guidance recommends that parents should
decide whether to enroll an individual child in swim lessons based on
the child’s frequency of exposure to water, emotional development,
physical abilities, and certain health concerns related to pool water
infections and pool chemicals.
“Not every child
will be ready to learn to swim at the same age,” Dr. Weiss said.
“Swimming lessons can be an important part of the overall protection,
which should include pool barriers and constant, capable supervision.”
The AAP does not
recommend formal water safety programs for children younger than 1 year
of age. The water-survival skills programs for infants may make
compelling videos for the Internet, but no scientific study has yet
demonstrated these classes are effective, the policy states.
policy also outlines the danger of body entrapment and hair entanglement
in a pool or spa drain. Special drain covers and other devices that
release the pressure in a drain can prevent such incidents.
AAP offers specific advice for parents:
Never – even
for a moment – leave small children alone or in the care of another
young child while in bathtubs, pools, spas or wading pools, or near
irrigation ditches or standing water. Bath seats cannot substitute
for adult supervision. Empty water from buckets and other containers
immediately after use. To prevent drowning in toilets, young children
should not be left alone in the bathroom.
supervise children in and around water. With infants, toddlers and
weak swimmers, an adult should be within an arm’s length. With older
children and better swimmers, an adult should be focused on the child
and not distracted by other activities.
If you have a
pool, install a four-sided fence that is at least 4 feet high to limit
access to the pool. The fence should be hard to climb (not
chain-link) and have a self-latching, self-closing gate. Families may
consider pool alarms and rigid pool covers as additional layers of
protection, but neither can take the place of a fence.
to learn to swim. AAP supports swimming lessons for most children 4
years and older. Classes may reduce the risk of drowning in younger
children as well, but because children develop at different rates, not
all children will be ready to swim at the same age.
an open body of water for children to swim in, select a site with
lifeguards. Swimmers should know what to do in case of rip currents
(swim parallel to the shore until out of the current, then swim back
to the shore).
The American Academy of
Pediatrics is an organization of 60,000 primary care pediatricians,
pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children,
adolescents and young adults. For more information, visit www.aap.org.