This is written in response to the thoughtful letters submitted by Drs Carr and Ward. Both have pointed out that formal swimming lessons can vary greatly in content and quality. Thus, knowing what specific types of lessons are most beneficial for young children would be useful for parents and pediatricians. We agree that this type of information is extremely important.
Although collecting such data is ideal, doing so poses methodological challenges. Despite the fact that drowning is a leading cause of death among toddlers, it is still a rare event; thus, collecting sufficient data on drowning cases to make valid comparisons between groups of children who received different types of lessons would require a much larger study. In our study, parents who responded that their children had participated in formal swimming lessons were subsequently asked specifics about those lessons, including the name of the course, where the classes were taught (the type of facility and sponsoring organization), the type of body of water (eg, pool or lake), the skills covered (eg, feeling comfortable in the water, poolside safety, treading water, floating on one's back, and basic swimming strokes), and other factors. However, given the small number of children who drowned who had participated in formal swimming lessons, we could not conduct subgroup analyses.