Infant swimming

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Father with baby getting used to a swimming pool Father with Babygirl in a swimming pool - cropped.jpg
Father with baby getting used to a swimming pool
Baby submerged, instinctively holding his breath underwater. Barnbarn.jpg
Baby submerged, instinctively holding his breath underwater.

Infant swimming is the phenomenon of human babies and toddlers reflexively moving themselves through water and changing their rate of respiration and heart rate in response to being submerged. The slowing of heart rate and breathing is called the bradycardic response. [1] It is not true that babies are born with the ability to swim, though they have primitive reflexes that make it look like they are. Newborns are not old enough to hold their breath intentionally or strong enough to keep their head above water, and cannot swim unassisted.

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Most infants, though not all, will reflexively hold their breath when submerged to protect their airway and are able to survive immersion in water for short periods of time. [2] Infants can also be taken to swimming lessons. Although this may be done to reduce their risk of drowning, the effects on drowning risk are not reliable. [3] Babies can imitate swimming motions and reflexes, but are not yet physically capable of swimming.

A submersion of the head may last only a few seconds. [4] A German physician pointed out the health risks of infant diving and the sometimes serious consequences as early as 1986, writing that since the introduction of baby swimming in Germany, several hundred infants had died from brain complications as a result of sinusitis and otitis that occurred after diving. Pediatricians also reported cases of cardiac arrest or respiratory failure. [5]

Infant swimming or diving reflex

Most human babies demonstrate an innate swimming or diving reflex from birth until the age of approximately six months, which are part of a wider range of primitive reflexes found in infants and babies, but not children, adolescents and adults. Other mammals also demonstrate this phenomenon (see mammalian diving reflex). This reflex involves apnea (loss of drive to breathe), slowed heart rate (reflex bradycardia), and reduced blood circulation to the extremities such as fingers and toes (peripheral vasoconstriction). [1] During the diving reflex, the infant's heart rate decreases by an average of 20%. [1] The glottis is spontaneously sealed off and the water entering the upper respiratory tract is diverted down the esophagus into the stomach. [6] The diving response has been shown to have an oxygen-conserving effect, both during movement and at rest. Oxygen is saved for the heart and the brain, slowing the onset of serious hypoxic damage. The diving response can therefore be regarded as an important defence mechanism for the body. [7]

Drowning risk

Drowning is a leading cause of unintentional injury and death worldwide, and the highest rates are among children. Overall, drowning is the most common fatal injury among children aged 1–4 years in the USA, [8] and is the second highest cause of death altogether in that age range, after congenital defects. [9] [10]

A Centers for Disease Control and Prevention study in 2012 of United States data from 2005 to 2009 indicated that each year an average of 513 children aged 0–4 years were victims of fatal drowning and a further 3,057 of that age range were treated in U.S. hospital emergency departments for non-fatal drowning. Of all the age groups, children aged 0–4 years had the highest death rate and also non-fatal injury rate. In 2013, among children 1 to 4 years old who died from an unintentional injury, almost 30% died from drowning. [8] These children most commonly drowned in swimming pools, often at their own homes. [9] [10]

Swimming lessons for infants

A mother holding her baby during a swimming lesson Swimming Lesson.jpg
A mother holding her baby during a swimming lesson

Traditionally, swimming lessons started at age four years or later, as children under four were not considered developmentally ready. [11] However, swimming lessons for infants have become more common. The Australian Swimming Coaches and Teachers Association recommends that infants can start a formal program of swimming lessons at four months of age and many accredited swimming schools offer classes for very young children, especially towards the beginning of the swimming season in October. [12] In the US, the YMCA [13] and American Red Cross offer swim classes. [14] A baby has to be able to hold his or her head up (usually at 3 to 4 months), to be ready for swimming lessons. [15]

Children can be taught, through a series of "prompts and procedures," to float on their backs to breathe, and then to flip over and swim toward a wall or other safe area. Children are essentially taught to swim, flip over and float, then flip over and swim again. Thus, the method is called "swim, float, swim." [16] [17]

Pros and cons of infant swimming lessons

In a 2009 retrospective case-control study that involved significant potential sources of bias, participation in formal swimming lessons was associated with an 88% reduction in the risk of drowning in 1- to 4-year-old children, although the authors of the study found the conclusion imprecise. [18] [19] Another study showed that infant swimming lessons may improve motor skills, but the number of study subjects was too low to be conclusive. [20]

There may be a link between infant swimming and rhinovirus-induced wheezing illnesses. [21]

Others have indicated concerns that the lessons might be traumatic, that the parents will have a false sense of security and not supervise young children adequately around pools, or that the infant could experience hypothermia, suffer from water intoxication after swallowing water, or develop gastrointestinal or skin infections. [22] [23]

Professional positions

In 2010, the American Academy of Pediatrics reversed its previous position in which it had disapproved of lessons before age 4, [11] indicating that the evidence no longer supported an advisory against early swimming lessons. However, the AAP stated that it found the evidence at that time insufficient to support a recommendation that all 1- to 4-year-old children receive swimming lessons. The AAP further stated that in spite of the popularity of swimming lessons for infants under 12 months of age and anecdotal evidence of infants having saved themselves, no scientific study had clearly demonstrated the safety and efficacy of training programs for infants that young. The AAP indicated its position that the possible benefit of early swimming instruction must be weighed against the potential risks (e.g., hypothermia, hyponatremia, infectious illness, and lung damage from pool chemicals). [24]

The U.S. Centers for Disease Control and Prevention recommends swimming lessons for children from 1–4, along with other precautionary measures to prevent drowning. [9] [10] [25]

The Canadian Pediatric Society takes a middle-of-the-road approach. While it does not advise against swimming lessons for infants and toddlers, it advises that they can not be considered a reliable prevention for drowning, and that lessons for children less than 4 years should focus on building confidence in the water and teaching parents and children water safety skills. They also recommend, for all children less than 4 years, constant arms-length supervision for toddlers near any body of water (including bathtubs) and that infants be held at all times. [26]

Related Research Articles

<span class="mw-page-title-main">Swimming</span> Self propulsion of a person through water

Swimming is the self-propulsion of a person through water, or other liquid, usually for recreation, sport, exercise, or survival. Locomotion is achieved through coordinated movement of the limbs and the body to achieve hydrodynamic thrust that results in directional motion. Humans can hold their breath underwater and undertake rudimentary locomotive swimming within weeks of birth, as a survival response. Swimming requires stamina, skills, and proper technique.

<span class="mw-page-title-main">SIDS</span> Sudden unexplained death of a child who is less than one year of age

Sudden infant death syndrome (SIDS), sometimes known as cot death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00 a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths.

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

<span class="mw-page-title-main">Drowning</span> Respiratory impairment caused by submersion in liquid

Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome.

<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old, generally caused by blunt trauma, vigorous shaking, or a combination of both. SBS is the leading cause of fatal head injuries in children under two, with a risk of death of about 25%. The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas.

<span class="mw-page-title-main">Preterm birth</span> Birth at less than a specified gestational age

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies or premmies. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision. The earlier a baby is born, the greater these risks will be.

<span class="mw-page-title-main">Pacifier</span> Rubber, plastic or silicone nipple for infants or toddlers to suck upon

A pacifier is a rubber, plastic, or silicone nipple substitute given to an infant or toddler to suckle upon between feedings to quiet its distress by satisfying the need to suck when it does not need to eat. Pacifiers normally have three parts: an elongated teat, a handle, and a mouth shield which prevents the child from swallowing or choking on it.

<span class="mw-page-title-main">Birth weight</span> Weight of a human baby at birth

Birth weight is the body weight of a baby at their birth. The average birth weight in babies of European and African descent is 3.5 kilograms (7.7 lb), with the normative range between 2.5 and 4.0 kilograms. On average, babies of Asian descent weigh about 3.25 kilograms (7.2 lb). The prevalence of low birth weight has changed over time. Trends show a slight decrease from 7.9% (1970) to 6.8% (1980), then a slight increase to 8.3% (2006), to the current levels of 8.2% (2016). The prevalence of low birth weights has trended slightly upward from 2012 to the present.

<span class="mw-page-title-main">Bronchopulmonary dysplasia</span> Medical condition

Bronchopulmonary dysplasia is a chronic lung disease which affects premature infants. Premature (preterm) infants who require treatment with supplemental oxygen or require long-term oxygen are at a higher risk. The alveoli that are present tend to not be mature enough to function normally. It is also more common in infants with low birth weight (LBW) and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome. It results in significant morbidity and mortality. The definition of bronchopulmonary dysplasia has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.

Freediving blackout, breath-hold blackout, or apnea blackout is a class of hypoxic blackout, a loss of consciousness caused by cerebral hypoxia towards the end of a breath-hold dive, when the swimmer does not necessarily experience an urgent need to breathe and has no other obvious medical condition that might have caused it. It can be provoked by hyperventilating just before a dive, or as a consequence of the pressure reduction on ascent, or a combination of these. Victims are often established practitioners of breath-hold diving, are fit, strong swimmers and have not experienced problems before. Blackout may also be referred to as a syncope or fainting.

<span class="mw-page-title-main">Swimming lessons</span> Teaching swimming

Swimming lessons are the process of learning to swim. In most countries there is a definition of a number of swimming levels that are reached in the process of the curriculum. The respective certificates of swimming tests are required for further training in aquatic abilities. Many countries have defined a minimum swimming level that children should reach by the end of primary education, in most cases with the help of school swimming classes being part of the normal curriculum.

Primitive reflexes are reflex actions originating in the central nervous system that are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli. These reflexes are suppressed by the development of the frontal lobes as a child transitions normally into child development. These primitive reflexes are also called infantile, infant or newborn reflexes.

Injury prevention is an effort to prevent or reduce the severity of bodily injuries caused by external mechanisms, such as accidents, before they occur. Injury prevention is a component of safety and public health, and its goal is to improve the health of the population by preventing injuries and hence improving quality of life. Among laypersons, the term "accidental injury" is often used. However, "accidental" implies the causes of injuries are random in nature. Researchers prefer the term "unintentional injury" to refer to injuries that are nonvolitional but often preventable. Data from the U.S. Centers for Disease Control show that unintentional injuries are a significant public health concern: they are by far the leading cause of death from ages 1 through 44. During these years, unintentional injuries account for more deaths than the next three leading causes of death combined. Unintentional injuries also account for the top ten sources of nonfatal emergency room visits for persons up to age 9 and nine of the top ten sources of nonfatal emergency room visits for persons over the age of 9.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, variously known as chestfeeding or nursing, is the process where breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommend that breastfeeding begin within the first hour of a baby's birth and continue as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

<span class="mw-page-title-main">Congenital cytomegalovirus infection</span> Medical condition

Congenital cytomegalovirus (cCMV) is cytomegalovirus (CMV) infection in a newborn baby. Most have no symptoms. Some affected babies are small. Other signs and symptoms include a rash, jaundice, hepatomegaly, retinitis, and seizures. It may lead to loss of hearing or vision, developmental disability, or a small head.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

SwimSafe is a basic swimming, water safety and rescue program designed specifically for children in low and middle income countries (LMICs) in Asia. It is a public health intervention aimed at preventing drowning. Originally devised to address childhood drowning in Bangladesh, it has been expanded across the region.

Infant and toddler safety are those actions and modifications put into place to keep babies and toddlers safe from accidental injury and death. Many accidents, injuries and deaths are preventable.

References

  1. 1 2 3 Goksor, E.; Rosengren, L.; Wennergren, G. (2002). "Bradycardic response during submersion in infant swimming". Acta Paediatr. 91 (3): 307–312. doi:10.1111/j.1651-2227.2002.tb01720.x. PMID   12022304. S2CID   22213714.
  2. ↑ Pedroso, FS (February 2012). "The diving reflex in healthy infants in the first year of life". Journal of Child Neurology. 27 (2): 168–71. doi:10.1177/0883073811415269. PMID   21881008. S2CID   29653062.
  3. ↑ Hassal, IB (1989). "Thirty-six consecutive under 5 year old domestic swimming pool drownings". Australian Paediatric Journal. 25 (3): 143–6. doi:10.1111/j.1440-1754.1989.tb01438.x. PMID   2764836. S2CID   31472695.
  4. ↑ Birgit Kienzle-Müller, Gitta Wilke-Kaltenbach: Babys in Bewegung. Urban & Fischer in Elsevier, 2015, page 26.
  5. ↑ Hans Rieckert: Sportmedizin - Kursbestimmung . Deutscher Sportärztekongress, Springer Verlag Berlin/ Heidelberg, Oktober 1986, page 63–64.
  6. ↑ Winston, Robert (1998). "The Human Body". BBC. Retrieved 18 August 2014.
  7. ↑ Alboni, Paolo; Alboni, Marco; Gianfranchi, Lorella (Feb 2011). "Diving bradycardia: a mechanism of defence against hypoxic damage". Journal of Cardiovascular Medicine. 12 (6): 422–427. doi:10.2459/jcm.0b013e328344bcdc. PMID   21330930. S2CID   21948366 . Retrieved 17 August 2014.
  8. 1 2 Percentage chart of the causes of death by unintentional injury, ages 1–4 (all races, both sexes), in 2013. Sample size: 1,316. Drowning: 29.9%, motor vehicle traffic accidents: 24.8%, suffocation: 12.2%, fire/burns: 9.8%, etc. National Center for Health Statistics (NCHS), National Vital Statistics System.
  9. 1 2 3 Laosee, Orapin C.; Gilchrist, Julie; Rudd, Rose (May 18, 2012). "Drowning - United States, 2005-2009". Center for Disease Control: Morbidity and Mortality Weekly Report. 61 (19): 344–347. PMID   22592273 . Retrieved 18 August 2014.
  10. 1 2 3 "Unintentional Drowning: Get the Facts". Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Retrieved 18 August 2014.
  11. 1 2 American Academy of Pediatrics, Committee on Sports Medicine and Fitness and Committee on Injury, Violence, and Poison Prevention. (2000). "Swimming Programs for Infants and Toddlers". Pediatrics. 105 (4 pt 1): 868–870. doi:10.1542/peds.105.4.868 . Retrieved 18 August 2014.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ "Swim Australia FAQs". Archived from the original on 16 October 2014. Retrieved 21 September 2014.
  13. ↑ "Parent/Child Swim Lessons (Ages 6-36 months)". New York's YMCA. Retrieved 18 August 2014.
  14. ↑ "Swimming Classes and Water Safety". American Red Cross. Retrieved 18 August 2014.
  15. ↑ Pratt, Sarah. "Infant Swimming Classes". Parenting. Retrieved 18 August 2014.
  16. ↑ Chief Judge Babcock (April 16, 2001). "Findings of Fact: Harvey Barnett, Inc. v. Shidler". Court Listener. 143 F. Supp. 2d: 1247. Archived from the original on 18 August 2014. Retrieved 18 August 2014.
  17. ↑ Court of Appeals for the Tenth Circuit (Aug 15, 2006). "Harvey Barnett, Inc. v. Shidler". Court Listener. Archived from the original on 18 August 2014. Retrieved 18 August 2014.
  18. ↑ Brenner, RA; Taneja, GS; Haynie, DL; Trumble, AC; Qian, C; Klinger, RM; Klebanoff, MA (Mar 2009). "Association between swimming lessons and drowning in childhood: a case-control study". Archives of Pediatrics & Adolescent Medicine. 163 (3): 203–10. doi:10.1001/archpediatrics.2008.563. PMC   4151293 . PMID   19255386.
  19. ↑ Moreno, MA; Furtner, F; Rivara, FP (Mar 2009). "Water safety and swimming lessons for children". Archives of Pediatrics & Adolescent Medicine. 163 (3): 288. doi:10.1001/archpediatrics.2008.572. PMID   19255402.
  20. ↑ Dias, JA; Manoel Ede, J; Dias, RB; Okazaki, VH (Dec 2013). "Pilot study on infant swimming classes and early motor development". Perceptual and Motor Skills. 117 (3): 950–5. doi:10.2466/10.25.PMS.117x30z2. PMID   24665810. S2CID   28391494.
  21. ↑ Schuez-Havupalo, L; Karppinen, S; Toivonen, L; Kaljonen, A; Jartti, T; Waris, M; Peltola, V (Jul 7, 2014). "Association between infant swimming and rhinovirus-induced wheezing". Acta Paediatrica. 103 (11): 1153–1158. doi:10.1111/apa.12736. PMID   25041066. S2CID   20295117.
  22. ↑ Weeks, Carly (July 13, 2009). "Water Safety: Can a six-month-old save himself from drowning?". The Globe and Mail. Retrieved 18 August 2014.
  23. ↑ "US babies learn 'self-rescue' from drowning". France-Presse. July 23, 2011. Retrieved 18 August 2014.
  24. ↑ American Academy of Pediatrics Committee on Injury, Violence, and Poison, Prevention (Jul 2010). "Prevention of drowning". Pediatrics. 126 (1): 178–85. doi:10.1542/peds.2010-1264. PMID   20498166 . Retrieved 18 August 2014.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. ↑ "Drowning Happens Quickly– Learn How to Reduce Your Risk". Centers for Disease Control and Prevention. Retrieved 18 August 2014.
  26. ↑ Hong Nguyen, B (2003). "Swimming lessons for infants and toddlers". Paediatrics and Child Health. 8 (2): 113–4. doi:10.1093/pch/8.2.113. PMC   2791436 . PMID   20019931.
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