Not One More Child Drowns

As a private practice pediatrician in Florida, I routinely discuss accident prevention and water safety at well-visits, specifically addressing 4-sided pool fencing and arm’s-length supervision. Brenner and colleagues' recent article, “Association Between Swimming Lessons and Drowning in Childhood: A Case-Control Study,”¹ has added to the confusion in how to advise, for example, the parent of a 2-year-old with a backyard pool. The 2000 American Academy of Pediatrics (AAP) policy on swimming programs for infants and toddlers states that “children are generally not developmentally ready for formal swimming lessons until after their fourth birthday.”² In contrast, the 2003 AAP policy on prevention of drowning in infants, children, and adolescents stresses touch supervision, 4-sided pool fencing, and also addresses lessons, advising that the decision of “when to start a child in swimming lessons must be individualized.”³ Who makes this decision and on what should it be based?