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AAP revises drowning prevention policy

This May, the American Academy of Pediatrics issued a revised policy statement on drowning prevention. The document provides guidance and best practices to help pediatricians work with families and communities to decrease the risk of drowning.

Chief among the revisions is the new recommendation that children should begin learning to swim by age one.  

The new recommendation is based on a 2009 study that was published in the Archives of Pediatrics and Adolescent Medicine, in an article entitled “Association between swimming lessons and drowning in childhood: a case-control study.” The study found that there is an 88% reduction in the risk of drowning in the 1- to 4-year-old children after participation in formal swimming lessons.  

The new recommendation runs counter to the AAP’s prior recommendation that “organized group swimming instruction should be reserved for children more than 3 years old,” which was based in part by the notion that parents may develop a false sense of security if they think their young child can swim a few strokes.  

Additional research, however, has indicated that some level of water competency, even in the very young, helps children survive common drowning situations.  

In addition to updated recommendations on swim lessons, the policy statement examines certain at-risk populations, specifically those with underlying medical conditions such as epilepsy and autism.  

According to research, drowning is the most common cause of death from unintentional injury for people with epilepsy and children with epilepsy are at greater risk of drowning, both in bathtubs and in swimming pools. 

Research has shown that the relative risk of fatal and nonfatal drowning in patients with epilepsy varies greatly but is 7.5- to 10-fold higher than that in children without seizures. 

Drowning rates vary with age, severity of illness, degree of exposure to water and level of supervision.    

Children with autism spectrum disorder are also at increased risk of drowning-especially those younger than 15 years of age and those with greater degrees of intellectual disability. 

It is thought that the propensity of autistic children to wander is the most common reason for drowning, accounting for nearly 74% of fatal drowning incidents among children with autism. Further, children with autism tend to be attracted to water. Other studies have shown that children with autism drown 160 times more frequently than the general population.

The AAP also referenced racial and socioeconomic disparities in drowning rates among children.  

According to the AAP, “decreased municipal funding for swimming pools, for swimming programs, and for lifeguards has limited access to swim lessons and safe water recreational sites for many communities.”  

And for some communities, religious beliefs require single sex aquatic settings and modest clothing for swimming, which may not be allowed in some pools.  

AAP’s revised policy states:

“These barriers to swimming may be surmounted through community-based programs targeting high-risk groups by providing free or low-cost swim lessons, developing special programs to address cultural concerns as well as developing swim lessons for youth with developmental disabilities, changing pool policies to meet the needs of specific communities, using culturally and linguistically appropriate instructors to deliver swim lessons, and working with both health care and faith communities to refer patients and their families to swim programs.”

The full revised policy can be found at pediatrics.aappublications.org. 

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