This study showed that, although there was general agreement with arm’s reach pool supervision, caregivers of toddlers perceived arm’s reach pool supervision to be less necessary when there are additional layers of protection in place, like if the toddler is wearing a flotation device, swimming in shallow water, or being watched by an older child or teen. Additionally, results highlight that the caregiver’s self-reported swimming capability to swim the length of a standard pool impacted their perceptions, with poor swimmers showing less support for arm’s reach pool supervision than good swimmers and non-swimmers.
This study demonstrated that caregivers generally support the need for arm’s reach pool supervision, with the average perceptions of arm’s reach pool supervision score showing agreement, and with over 60% of respondents agreeing or strongly agreeing with each statement about arm’s reach supervision. However, results also showed that support for arm’s reach pool supervision may depend on situational factors. Despite 39% of respondents strongly agreeing with a general statement that caregivers should keep toddlers within arm’s reach while in the pool, when asked about scenarios where there is a another child or teen with the toddler, the toddler is in a lifejacket, or the toddler is in water that is not above their head, fewer than 30% of respondents strongly agreed (Table 1). It is not uncommon for toddlers to drown in seemingly safer situations, like being in shallow water or watched by older kids, (Quan et al. 2011) so it is concerning that caregivers would be willing to reduce the closeness of their supervision in these scenarios. Drowning prevention requires multiple layers of protection. Drowning prevention messaging should highlight how adding a layer of protection, like using a lifejacket or taking swimming lessons, does not mean that other layers can be lessened and that attentive, close supervision is a critical layer of protection for all swimming scenarios.
This study showed that perceptions of arm’s reach pool supervision are impacted by the relationship the caregiver has to the child, with siblings showing less agreement with arm’s reach pool supervision compared with grandparents and parents. This cannot be attributed to age, though, as there was not a significant difference in perceptions found based on age. Our lack of a significant finding based on age is in contrast, however, with actual observations of caregiver supervision behavior, which show better supervision by younger adult caregivers (Petrass and Blitvich 2012). In this study, female caregivers showed more agreement with arm’s reach pool supervision than male caregivers. This is consistent with research showing that male caregivers see themselves as playing a less essential role in reducing drowning risk around water (Moran 2009). No significant differences in perceptions of arm’s reach pool supervision were found based on race in this study. However, a higher drowning burden in the USA for racial minorities indicates a need to address potential health disparities in drowning prevention efforts (Saluja et al. 2006).
The results of this study suggest that caregivers’ sense of whether they possess the swimming capability to save a drowning child impacts how close they believe a caregiver needs to be to a toddler when they are swimming. As might be expected, non-swimmers showed the highest support for keeping toddlers within arm’s reach when they are in a swimming pool. Within this group of non-swimmers, it is likely there are some who are scared of water. According to a survey by the American Red Cross, 30% of adult non-swimmers report being scared of the water (American Red Cross 2022). Potentially fear or discomfort works in toddlers’ favor, leading caregivers to have closer, more attentive supervision when they are not comfortable in the water or not capable of swimming.
Swimmers who are confident that they could swim 25 m without touching the bottom showed agreement with arm’s reach pool supervision. It could be predicted that adults who are most comfortable with their own swimming capability would be the most lax with supervision, but this is opposite of what we found. It is possible that capable swimmers have enough experience with swimming to be aware of how challenging it would be to swim across a pool to retrieve a drowning child. This understanding of what it might take to rescue a child might lead confident swimmers to value the need for arm’s reach supervision.
Though still in agreement with arm’s reach pool supervision, caregivers who responded Yes, but it would be hard and Probably not to whether they could swim 25 m without touching the bottom of the pool showed perceptions approaching a neutral attitude toward arm’s reach pool supervision. These poor swimmers comprised more than 1/3 of caregivers surveyed and pose a problematic situation for pool supervision. Poor swimmers' support for arm’s reach pool supervision is not as high as ideal, yet they don’t have the swimming capability that would likely be needed to save a drowning child that was not in arm’s reach. These findings suggest that a caregivers’ own experience and capability related to swimming impacts decisions they may make about supervision needs. It also highlights that it might be necessary to put in extra effort to reach caregivers who are poor swimmers since they have neither the experience of confident swimmers nor the fear or discomfort of non-swimmers that might drive these other groups to offer a higher level of drowning protection to the children they care for.
This study found that 39.2% of caregivers were NOT confident they could swim 25 m. Prior research on swimming capability of adults in the USA has shown similar results. The Red Cross reports that 35% of adults in the USA say they can NOT swim 25 m (American Red Cross 2022). These data show that a high proportion of adults cannot swim even one length of a standard pool. This means that more than one-third of adults who may be supervising a child in the water are not prepared to intervene if that child was drowning.
The high percentage of caregivers who cannot easily swim 25 m in addition to the lower support for arm’s reach supervision among poor swimmers suggests that it is not just children that need swimming lessons. Drowning prevention recommendations should include suggestions for caregivers to improve their own water competency in order to be more prepared for supervising children in or around bodies of water. Additionally, it could be suggested that parents, when designating a supervisor for children in the water, should not just ask whether that supervisor is capable of watching the child but whether that supervisor is capable of rescuing a child in need. This research supports the AAP recommendation that supervisors of beginning or non-swimmers should be constantly attentive, in close proximity (i.e., within arm’s reach), and prepared to intervene (Denny et al. 2019).
There are limitations to the conclusions that can be drawn from our findings. Although a number of variables were statistically significant, because the survey was only validated statistically, it cannot be assumed that the differences are functionally or clinically significant, in practice. Additionally, some variables’ standard deviations overlapped, suggesting more overlap between scores than statistical differences might suggest.
This study provides insightful data on swimming capability, but the information received was all self-report. Research shows that self-reported swimming capability and actual swimming capability are not always matched (Petrass et al. 2012). Additionally, perceptions of arm’s reach pool supervision asked generally about the need for arm’s reach supervision for toddlers in different swimming pool scenarios, not about the caregiver’s actual supervision behavior. Research previously published on this same group of participants showed that the perceptions of arm’s reach pool supervision scale we used in this paper is predictive of self-reported supervision behavior of the caregiver with their own toddler (Johnson et al. 2021). However, these self-reported perceptions and behaviors may not reflect the actual behavior adopted by these caregivers when they are supervising the toddler they care for. More observational research is needed to understand actual supervision behavior. Future research should also explore child drowning rescue attempts to better understand what scenarios or decisions could add unnecessary seconds or minutes to the rescue time, delaying rescue attempts. Research could highlight how often a caregiver asks a bystander to retrieve the child or leaves the scene to get someone else to rescue the child. Research on supervision around bodies of water and on actual drowning incidents can help highlight how caregivers can be better prepared to intervene in a drowning situation. Additionally, a better understanding of the risks posed to people attempting to rescue a drowning person are needed in order to keep caregivers and bystanders from undue risk to their own lives when someone else is drowning.