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?

I am aware of several different types of aquatic programs: structured play, water-adjustment classes, swimming readiness, swimming lessons, aquatic survival, and modified adult stroke lessons. Which type of program will best prepare children to survive an aquatic accident? As the mother of 3 young and active boys, I researched and found a program with hierarchical supervision, years of research, and individualized lessons that addressed daily bowel movements, urine, diet, sleep, injury, and medication history for each child prior to each lesson and also included constant parental involvement and safety education. I watched my children become skilled in the water, gain confidence, and even practice their skills fully clothed in a safe, monitored lesson environment. As a parent, I am thrilled with the results of the individualized decision my family made. As a pediatrician, I am frustrated that the AAP and researchers are not providing my colleagues and me with more tools to help parents differentiate various formal lessons from those specifically focused on helping their child survive an aquatic incident.

In 2005, drowning was the leading cause of all deaths in Florida and the nation for children aged 1 to 4 years.⁴ The potential for a possible 88% reduction in drowning risk, as Brenner and colleagues' study suggests, is welcome news to me as both a parent and a pediatrician. However, it is only when we as pediatricians can help parents make specific, informed, and individualized decisions about the kind of lessons most appropriate to reduce drowning that any actual impact will be made.

Correspondence: Dr Ward, 2973 Landover Blvd, Spring Hill, FL 34608 (jjw11@netzero.com).

Financial Disclosure: None reported.