Drowning Interventions

Swimming Lessons

Background

Most swimming lessons for preschool-aged children focus on basic skills such as entering the water safely, becoming comfortable with floating in the water, proper techniques of breathing, and propelling oneself across short distances. As the children become more advanced in motor skills, more difficult tasks may be learned, such as swimming underwater, retrieving objects from the bottom of the pool, and diving. 

Some communities have implemented mandatory, school-based swimming lessons for young children. Going one step further, public high schools in Hawaii have implemented a program that requires students to complete a drownproofing course.1 The technique taught in this course allows for minimal energy expenditure while maximizing survival time. The maximal period one can stay afloat in the water depends, however, on consciousness, surf conditions, body heat loss, and other injuriesall of which are difficult to simulate in a high school pool setting.  

Although a number of studies2-5 have shown that swimming lessons improve ones ability to dive, swim underwater, breathe correctly, and tread water, no study has examined the more important question of whether swimming lessons and/or drownproofing courses actually prevent drownings and near-drownings. 

We were able to find only two studies which evaluated the short term effect of swimming lessons in children, described below. 


Review of swimming lesson intervention studies: 
 

Author

Asher et al., 1995

Study design and target population

Randomized controlled trial (RCT) 

Children 24-42 months old.

Intervention

Training in swimming skills and water safety training for 16 (8-week course) or 24 lessons (12-week course), adapted from the Red Cross program.

Outcomes

Swimming ability, deck behavior, water recovery, and swimming to side after jumping into pool.

Results

For both groups, significant improvement (p<0.005) in swimming ability, small improvement (p=0.03) in pool safety behavior, significant improvement (p<0.001) in ability to recover from simulated fall into pool (before v. after). No substantial differences between 8 and 12 week groups.

Study quality and conclusions

Strong evidence for the effect of the intervention on the outcome; unknown generalizability of the results to real world settings. Long-term effect of intervention (without reinforcement) unknown.


Author

Erbaugh, 1986

Study design and target population

Non-equivalent control group study 

Children 3-4 years old.

Intervention

Individual instruction in swimming skills (20 lessons over 8 months) in three groups: returning, beginning, or control (no lessons) children.

Outcomes

Locomotion (front and back), kicking, entry, diving, and ring pick-up.

Results

Returning children significantly better (p<0.01) in all outcome scores than starting children at end of 8 month period. Beginning children significantly better (p<0.01) in all outcomes except diving than control group.

Study quality and conclusions

Evidence of superior swimming skills due to retention of earlier lessons. 

Swimming skills of preschool children extremely sensitive to training; advanced skills (diving) mastered in concordance with motor skills.

Summary of swimming lesson studies 

There is strong evidence that swimming lessons improve swimming performance. Preschool-aged children in certified swimming programs show significant improvement in swimming ability and pool deck behavior compared to those who do not take lessons. The earliest age at which swimming lessons show improvement in swimming ability is 24 months. Children are highly sensitive to training, are able to retain most skills if lessons are continued, and can use those acquired skills in mastering more advanced swimming skills (e.g., diving). 

Recommendations on swimming and water safety training programs 

While there is no reason to suspect that swimming lessons alone would increase the risk of drowning, the generalization of skills acquired from a certified instructor to real-world settings (e.g., rivers, lakes, swimming without adult supervision) cannot be determined from the studies conducted so far. Thus, while these programs appear promising, a recommendation on their more widespread implementation must await further study. 

Recommendations for future research 

Because drowning is not a frequent event, a randomized controlled trial or cohort study of the effect of swimming lessons would not be feasible. For this reason, a case-control study should be performed to address this issue, with drownings as the outcome, and swimming lessons as the exposure of interest. Because of their higher incidence, near-drownings might serve as an even better outcome for a case-control study if there exists a good index of near-drowning events. 

Other issues that need to be examined include the relationship between previous lessons and a childs ability to retain important safety skills. The interaction between a childs developing motor ability and time between lessons is an important factor in maintaining swimming and safety skills. How many lessons are enough? The effectiveness of swimming lessons may be thought of as necessarily carrying over to non-pool environments such as lakes, oceans, and rivers. This may not be true, however, for these other bodies of water. Lakes and oceans have boaters, tides, and often murkier and deeper water than most pools; rivers can have swift-moving water, hydraulic reversals, and other hazards such as rocks, root balls and log jams. Studies examining the effectiveness of swimming lessons for these non-pool locales would be instrumental.