QuickScan Reviews in Pediatrics, May 30 2009

Background: From 2000 through 2005, approximately 6900 children <20 years of age died from non-boat-related drowning; in those <5 years of age, the rate was 2.68 per 100,000 person-years. Although the use of pool fencing can be effective in preventing drowning, little is known about the effectiveness of other prevention strategies. While the American Academy of Pediatrics recommends formal swimming lessons for those 5 years of age, no recommendation exists for children aged <5 years. Objective: To determine if swimming lessons are associated with a lower risk of drowning in children 1 to 19 years of age. Design: Case-control study. Methods: Cases were drowning deaths identified through the medical examiner or coroner offices between 2003 and 2005. Cases came from Maryland, North Carolina, Florida, California, Texas, and New York. Controls were matched for age, sex, and county of residence; for children 1 to 4 years of age, controls were also matched for the presence of a swimming pool at home. Two controls were chosen for every case with complete information. Interviews were conducted with all case and control families to determine exposure to water, swimming ability, swimming lessons, development and temperament, risk taking, medical conditions, and child and household descriptive data. Results: Interviews took place for 88 case families and 213 control families. In children <5 years of age, 3% of cases had participated in formal swimming lessons compared to 26% of controls (OR, 0.12). In children aged 5 to 19 years, 27% had taken swimming lessons versus 53% of controls, although the difference was not statistically significant. Once analyses were controlled for covariates, however, none of the associations were statistically significant. Conclusions: Although the association was not strong, there was a large reduction in the risk of drowning in children aged 1 to 4 years who had participated in formal swimming lessons. In unadjusted analyses, children aged 1 to 4 years who had participated in formal swimming lessons were significantly less likely to die by drowning. This association was not significant in children aged 5 to 19 years. None of the associations were statistically significant once adjusted for confounding variables. Reviewer's Comments: Until now, some have argued that there was no evidence that swimming lessons were beneficial, and some believed they could be harmful. With this study, there are now suggestions that both those assertions are wrong. In this study, the small numbers of study subjects limited the importance of the results. Certainly, there is no shortage of children and swimming pools, so a larger study is needed.