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Sink or swim? Every year, hundreds of toddlers drown. But, surprisingly, the American Academy of Pediatrics warns parents against swimming lessons for youngsters. Does its argument hold water?

Michelle Feczko calls them "three tragic seconds," the moment toddlers slip out of parents' sight at a pool or waterpark, a moment that will haunt them forever.

As childhood injury prevention coordinator for Children's Hospital of Orange County, Calif., she has met with dozens of grief-stricken, guilt-ridden parents who swear that they turned from their child for just a few seconds before tragedy struck.

It's a story that gets repeated all too often across the country. Only car accidents claim more young lives each year than drowning, according to the Centers for Disease Control and Prevention in Atlanta, which tracks such statistics nationally. In 2001, the latest CDC statistics available, nine people a day drowned in the United States. Among the victims, 442 children under age 4 drowned--mostly in pools or natural bodies of water.

And for every child who drowns, three who nearly did wind up in the emergency room with brain damage.

By the time parents of drowned or nearly-drowned toddlers sit sobbing in the emergency room, it's too late for Feczko to talk to them about swimming lessons. Most aquatics professionals believe they are the best, most logical, defense against drowning, even among toddlers. But amazingly, Feczko and others like her, aren't so sure.

The main reason for the uncertainty is the American Academy of Pediatrics, an august body of 60,000 physicians who arguably know children better than anyone. That organization says parents should not enroll their kids in formal swimming lessons before age 4. Until then, their little limbs aren't strong enough to execute well-formed strokes, and their judgment is too immature to keep them from getting in--literally--over their heads. And besides, AAP argues, there is no research to prove that swimming lessons for children so young make them less likely to drown.

Of course, as swimming coaches are quick to point out, and the AAP concedes, there's no research to prove that it makes them more likely to drown. Quite the contrary, say aquatics professionals. Their common sense and personal experience with thousands of diaper-swaddled youngsters tells them that early lessons make it possible for kids younger than 4 to hold their breath under water, maneuver themselves onto their backs to float, find their way to the side of the pool and even do laps--skills that can mean life or death when it comes to water survival.

Still, without proof, the AAP and the Feczkos of the world aren't ready to budge.

"Should they or shouldn't they? It's up to the parent," Feczko concludes. "I don't know that there's enough evidence to determine either way."

Believers on both sides have to admit that they base their cases mostly on observation and opinion rather than reams of research.

AAP's policy statement, for instance, relies heavily on a single, 10-year-old study that concludes that while 1-year-olds can "perform rudimentary swimming movements," the under-4 swimmer is limited by "neuromuscular capacity" and learns slower.

Another report from 1997 that influenced authors of the AAP recommendation notes that while toddlers as young as 34 months can learn water survival skills during training, there's no proof that those skills lower their risk of drowning.

Children learn better, the academy concludes, if they are "developmentally ready," and they're not until they turn 4.

But Johnny Johnson, a Tustin, Calif., swim school owner and immediate past president of the U.S. Swim School Association, calls those assertions "irresponsible."

"It's irresponsible to throw out one way or the other without empirical research," he says. "They are really taking a stand on something they can't prove."

Johnson admits that he can't back his own position with formal research. Still, he estimates that half of the 500,000 children enrolled in lessons at 300 U.S. Swim School Association schools are younger than 4. The AAP thinks those numbers are even higher. It estimates that 5 to 10 million infants and preschool children participate in formal aquatic instruction programs.

And why not? Johnson contends that children that age are old enough to learn how to take a breath before submerging, hold it under the water, float and roll over onto their backs just months into their new lives. His association, he notes, recommends swimming lessons for babies who have had their inoculations--which usually occurs when they are 3 to 6 months old.

He put his own kids in the water before they were 2 months old, he says, and entered them in swim meets when they were 3.

"A child with zero skills is at great risk of drowning," he says. "Through the experience of being in the water, children do learn accountability for their actions. They learn the consequences of stepping off into the deeper water. They learn how to be mobile in the water, and they learn breath control in a controlled environment."

The AAP does not dispute that children can and do learn such skills. That swimming lessons occur in a controlled environment, however, is part of the reason some pediatricians warn against them for the preschool set.

"There's some concern that if you get kids excited about water really young, before they actually have cognition and skill sets, that you actually increase their risk of drowning," explains Dr. Julie Gilchrist, a pediatrician and an epidemiologist for the CDC's Injury Center.

She says babies and toddlers who learn swimming or water survival skills while wearing a bathing suit in a pool with a familiar instructor won't be able to apply what they've learned if they fall into someone else's pool while fully dressed or wander into a lake when nobody's looking.

Worse, parents tend to believe that kids who have had swimming lessons won't drown, notes Dr. Phyllis Agran, a professor in the Department of Pediatrics at the University of California, Irvine, and chairwoman of AAP's Section on Injury and Poison Prevention.

"There is harm if parents rely on it, if parents have an increased sense of security and if a child thinks he's okay in the water," she says.

Indeed, she adds, that's true for kids of all ages: "Good swimmers drown."

That they do is not in dispute.

Some of the victims had swimming lessons, although there is no data to say how many. In a 1996 Consumer Product Safety Commission study of children younger than 5 who drowned in residential pools, researchers suggested that the ability to swim decreased the chances that a child would drown, but they admitted that they couldn't be sure.

Until someone is sure, AAP is sticking to its recommendation. "We're trying to be the scientists who review the medical and scientific literature and digest it for people and put it into a policy that is evidence-based," says Dr. Jeff Weiss, head of Phoenix Children's Hospital and a member of AAP's Committee on Injury, Violence and Poison Prevention.

"If somebody did a study of swimming schools that shows kids who took lessons at 2 years old had a 10 percent less drowning rate, the academy would look at that and change its policy."

Dr. Kent Denmark, pediatric emergency medicine residency director at Loma Linda University Children's Hospital in California, says he hopes to partner with the U.S. Swim School Association to learn if kids who took swimming lessons are less likely to drown.

Meanwhile, the AAP recommendation does not warn parents away from enrolling their little ones in water-acclimation classes that get babies and toddlers into a pool with a parent to splash around, blow bubbles and have fun.

Such classes, says Margey Lame, a health and safety specialist with the Orange County Red Cross, "keep the pressure off. We're not actively trying to get them to learn how to swim before they're ready."

And while the American Red Cross officially supports AAP's position, it doesn't exactly enforce it, either. "We shy away from giving exact ages when the child can learn how to swim," says spokeswoman Stacey Grissom. "Children develop at different levels. One child may take off and exceed expectations, one may need more time."

So-called "mommy and me" classes aren't a problem for Agran and her AAP colleagues, the doctor says. The problem comes when instructors advertise their lessons as a way to "drown-proof" babies. "It's false and it's misleading. It's not a drowning-proof prevention strategy and it's misleading to suggest that it is," Agran warns.

What does prevent kids from drowning, she says, is diligent adult supervision--so close that the parent is within arm's reach of a child who's in the water; and CPR training for adults responsible for pool-bound tots.

Angela Mickalide, program director for the Washington, D.C.-based National Safe Kids Campaign, agrees. Her organization, which recommends that every child take swimming lessons between ages 4 or 5 and age 8, studied death reports of 500 children who drowned in 2000 and 2001. The result: Nine out of 10 died while someone was supervising them. In 72 percent of the cases, the supervisors were parents or other adult relatives who admitted splitting their attention between watching the child and reading, talking on the phone, eating or chatting with friends.

"It's very important that parents understand that drowning happens very quickly," says Mickalide, who notes it takes less than 10 seconds underwater in most cases.

Indeed, some of the recommended safety measures have led to a reduction in the drowning rate for small children since 1987, says Mickalide.

But Johnson says swimming lessons deserve some of the credit. "Children drown because they get into the water when they have no personal skills," he says.

Keeping unsupervised kids out of the water with barrier fences is critical, he agrees, as are close supervision and the ability of an adult to resuscitate a child who gets into trouble. But he says the AAP and those who endorse its recommendation omit the fourth drowning-prevention strategy for the age group most likely to die in a pool: swimming lessons.

"None of their drowning-prevention measures address empowering the potential victim with the skills where they can save their lives in the water," he says. "That's what swimming instruction does."

The Doctors' Advice

The American Academy of Pediatrics recommendations regarding swimming lessons for toddlers:

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 arms' 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.

7 Pediatricians should support data collection, drowning prevention research, and legislation aimed at reducing the risk of drowning in young children in and around water.
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Author:O'Malley, Sharon
Publication:Aquatics International
Geographic Code:1USA
Date:Jun 1, 2005
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