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Swimming lessons associated with reduced risk of drowning in toddlers
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CHICAGO—ages 1 to 4 appear to have a lower risk of drowning if they have taken formal swimming lessons, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.



Between 2000 and 2005, 6,900 children younger than 20 died of non-boating–related drowning, according to background information in the article. Interventions to prevent these events depend on the circumstances and the age of the victim—for instance, pool fencing helps protect toddlers who gain unauthorized access to a pool, but does not prevent drowning among children near a lake or canal. The American Academy of Pediatrics currently recommends that all children be taught to swim after age 5 years as a preventive strategy, but does not recommend for or against swimming lessons in younger children because of a lack of data.

Ruth A. Brenner, M.D., M.P.H., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md., and colleagues studied the association between drowning and swimming lessons in children and adolescents age 1 to 19 in six states. Interviews were conducted with 88 children families of children who drowned between 2003 and 2005 and also with the families of 213 control children who were the same age and sex and lived in the same county as those who had drowned.

Among children ages 1 to 4 years, two of the 61 who had drowned (3 percent) had ever taken formal swimming lessons, compared with 35 of the 134 controls (26 percent), representing a statistically significant reduction in the odds of drowning among children who had taken swimming lessons. Parents reported that children who drowned were less skilled swimmers—for example, only 5 percent of them were able to float on their back for 10 seconds, vs. 18 percent of controls.

Of the 27 children age 5 to 19 who drowned, seven (27 percent) had ever taken formal swimming lessons, compared with 42 of the 79 controls (53 percent). However, the association between swimming lessons and drowning was not statistically significant. As with younger children, those who drowned were reported to be poorer swimmers, with 42 percent being unable to swim continuously for at least one minute (vs. 16 percent of controls).

"Previous concerns have been raised about the potential for swimming lessons to increase the risk of drowning, either through increased exposure to water or through decreased parental vigilance as parents become more confident in their child's swimming ability," the authors write. However, these results and those of similar studies provide reassurance that swimming lessons may have a protective effect.

"In combination with other prevention strategies, such as pool fencing, appropriate adult supervision and training in cardiopulmonary resuscitation, swimming instruction can now be viewed as a potential component of a multifaceted approach to prevention for younger children," the authors conclude. Still, parents should be cautioned that swimming skills alone cannot completely protect children and that even the most proficient swimmers can drown, they note.
(Arch Pediatr Adoles Med. 2009;163[3]:203-210. Editor's Note: This work was supported by the National Institute of Child Health and Human Development. Complete or partial salary support for Dr. Brenner and co-authors Dr. Taneja, Dr. Haynie, Dr. Trumble and Dr. Klebanoff was provided from National Institute of Child Health and Human Development intramural funds. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: The Time to Prevent Drowning Is Now

Drowning kills nearly 200,000 children each year, defies the most advanced medical care and affects those in high-income developed countries as well as in the developing world, writes Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and editor of Archives of Pediatrics & Adolescent Medicine, in an accompanying editorial.

"It is against this setting that the article by Brenner and colleagues in this issue of the Archives must be viewed and why it is so important," Dr. Rivara continues. "This widely anticipated case-control study found that formal swimming lessons were strongly associated with a lower risk of drowning for preschool children aged 1 to 4 years. This is the age group at greatest risk of drowning and for which the idea of swimming lessons has been most controversial."

"Other interventions to prevent drowning are also important, such as pool fencing, use of personal floatation devices and supervised swim areas," Dr. Rivara concludes. "Swimming lessons should not replace these other strategies nor should they substitute for adult supervision and vigilance. However, formal swimming lessons offer an opportunity to make a real difference in communities around the globe to prevent the sound of happy children splashing in water from turning into the wail of an ambulance siren or the sound of a parent crying in grief."
(Arch Pediatr Adoles Med. 2009;163[3]:277-278. Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .

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