Basic swimming or water safety skills training for drowning prevention in children: an updated systematic review

Yana Criel^1*Pieter Severijns^1,2Hans Scheers^1,2Emmy De Buck^1,2,3

• ¹Belgian Red Cross-Flanders, Centre for Evidence-Based Practice, Mechelen, Belgium
• ²Department of Public Health and primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
• ³Cochrane First Aid, Mechelen, Belgium

Background: Child drownings constitute a major cause of mortality from unintentional injury worldwide. In 2021, the WHO issued a strong recommendation in favour of basic swimming skills and water safety training in children to prevent drowning. The systematic review conducted in support of this guideline, however, revealed evidence of overall very low certainty and illustrated a number of research gaps. Here, the evidence from this systematic review was updated. Methods: Five scientific databases (PubMed, Embase, The Cochrane Library, Web of Science, ERIC) and two clinical trial registers (clinicaltrails.gov, WHO ICTRP) were searched for controlled experimental and observational studies. Interventions delivering basic swimming skills or water safety in children under the age of 18 years were included. Outcomes of interest included drowning-related mortality and morbidity, and water safety skills, knowledge and behaviour. Certainty of the evidence was appraised using the GRADE methodology. Results: A total of 33 studies were included, of which 21 were previously included in the original review and 12 were newly identified in the current update. Studies delivered either basic swimming skills (18 studies), isolated water safety training (6 studies), water safety training as part of an injury prevention programme (5 studies) or an intervention combining swimming and water safety (4 studies). Certainty of the evidence ranged from high to very low. Conclusions: Swim training may reduce drowning-related mortality and increase water safety skills in children. The used pedagogical approach (focus on familiarization and motor awareness), mode of delivery (using video-taped feedback) and setting (shallow water) may be determining factors for swimming skills acquisition. Water safety training is effective to enhance knowledge of and safe behaviour in/around water, and may reduce drowning mortality. These results, highlighting the importance of promoting swimming and water safety skills from an early age onward, could inform public health strategies and guide the development of sustainable interventions in communities at high risk of drowning.