On the last day of her ISR swim lesson, Maria Feeney’s one-and-half-year-old daughter Biella picked out a Sophia the First dress to wear. Later that day, as Feeney watched, an instructor placed a dressed Biella in a pool face down multiple times: once, while seated facing the water, another while seated with her back to the water, a final time dropped into the pool feet-first from above. Each time, Biella successfully flipped over and floated on her back. She passed with flying colors. By age two, she was swimming the length of a pool underwater independently.
In recent years, videos have circulated online of infants during swim lessons, face down in pools, struggling to flip over as adults stand by, eventually making it to their back and floating serenely. For some this is a sight of abject horror and obvious neglect. For those familiar with ISR swim lessons, it’s simply how the process works.
Infant Swimming Resource (ISR) is the largest source for self-rescue lessons. The organization, which was founded in 1966, claims to have taught more than eight million lessons and saved more than 800 lives. ISR lessons were developed to teach very small children to save themselves in the event that they fall into water. Unlike traditional swimming lessons, which often take place in groups and teach different floats and swim strokes, ISR swim lessons focus on skills needed to stay alive until help arrives in the event that a child accidentally ends up in a body of water. All ISR graduates learn how to flip over and float on their back when placed in the water face down. Kids over the age of one also learn how to find the pool’s edge or stairs, and swim there underwater, taking float breaks when needed.
Parents seem to have fallen into two camps when it comes to ISR: those who believe it is a life-saving course that can prevent children from drowning, and those who believe it’s a recipe for childhood trauma.
Roughly ten people in the United States drown each day. Drowning is the fifth leading cause of traumatic death in the United States, according to data from the CDC. But children are especially vulnerable: drowning is the leading cause of death for kids ages one to four. As of May 2020, drowning rates in Florida and Texas — the states with the highest rates of childhood drowning in pools and spas — were higher than last year.
“A lot of us are worried about the summer when families may not be able to go to public pools and maybe more inclined to do something at their own home, and may not be thinking about water as the risks they represent to kids,” says Dr. Benjamin Hoffman, chair of the American Academy of Pediatrics Council on Injury, Violence and Poison Prevention. “Water represents a constant, real threat to children, whether it’s a bucket or a toilet, a little wading pool, or an in-ground swimming pool.”
ISR lessons go to great pains to replicate situations in which children might find themselves alone in the water. When children fall in pools, they’re most often wearing clothes, which can weigh several pounds when wet. Once instructors are confident that a child has mastered the flip and float, they have the child enter the water from the edge of the pool, face first, then with their back to the water, then dropped in feet down, all while fully clothed.
“What’s unique is that it could be taught without any verbal cues or instruction,” says Lara Buongiorno, an ISR instructor based in Manhattan. “The goal is for the child to respond to the water, not to a person. If he falls in the pool nobody will be there to say ‘okay 1, 2, 3 hold your breath.'”
ISR lessons start slow, are always one-on-one, and differ based on a child’s developmental stage, age, learning style, history with the water (including traumatic events), and whether they regularly use floaties. Some children start on the first day of lessons just by sitting on the stairs and talking about what’s going to happen. Others might submerge just their lips or nose.
When developing ISR, researchers found that learning efficiency plummets after 10 minutes, so lessons are kept short as children work towards small, achievable goals. Many lessons will last fewer than 10 minutes if a child gets too cold or tired.
The lessons are not without emotions. In the beginning, children sometimes cry. And Buongiorno says that if parents are uncomfortable with ever hearing their child cry, ISR might not be right from them. Her website pleads, “Parents who have lost a child to drowning will tell you they’d give everything to hear their child cry again.”
For parents nervous that ISR might be too intense, Buongiorno suggests they observe a lesson. Feeney says that the first few lessons were hard to watch, namely because her daughter was very attached and didn’t like the cold pool. By the third day, however, she was laughing and singing in the water.
ISR instructors follow a stringent set of safety precautions. Before enrolling their children in lessons with Buongiorno, for instance, parents must provide detailed records of their child’s health history review. Pediatric nurses review the records to screen for risk factors, such as a history of seizures. Before each lesson, parents complete a form detailing the child’s bowel, urine, diet, and sleep habits over the previous day. This helps instructors screen for signs that a child is ingesting pool water or needs to take it a little easier.
During lessons, instructors constantly monitor the child’s temperature and check for a distended stomach, which sometimes happens when kids are learning to hold their breath and swallow air. After lessons, students lay on their sides, which Buongiorno says is the medically designated recovery position. All certified ISR instructors undergo eight weeks of training, including at least 60 hours with students, and are given instruction in anatomy, physiology, child psychology, behavior, development, and sensorimotor learning.
ISR is generally more expensive than traditional swimming lessons, too, the idea being that they’re highly effective and don’t need to be repeated. Booster sessions are, however, recommended.
At ISR Manhattan, lessons cost $300 per week, for 6-8 weeks. In other states and cities, lessons are advertised starting at $75 per week. There is also a nationally standard $105 registration fee.
“I know that it’s a bit pricey, but it works,” says Feeney, whose twin two-year-old boys Conor and Declan were almost done with the course before COVID cut them short. “If you have any stress, it’s worth it.”
Research related to drowning is extremely limited, and the American Academy of Pediatrics says that while formal swimming lessons (not specifically ISR) for children ages 1-4 can reduce the overall risk of childhood drowning by 88 percent, there isn’t good evidence to support the use of one type of swimming lessons over another.
“Unfortunately, there’s not a lot of data on what parts of swimming lessons are important, what skills are important, how you know a child is ready,” Hoffman says. “That’s the essential problem with infant survival classes, there’s just no data to show that they work. It’s possible that they help. It’s also possible that they’re harmful.”
Though ISR offers swim lessons starting as young as six months, the AAP is firm in their stance that lessons should wait until a child’s first birthday. There’s no evidence that swimming lessons before the age of one are beneficial, and according to the AAP. “Infants younger than 1 year are developmentally unable to learn the complex movements, such as breathing, necessary to swim,” they note. “They may manifest reflexive swimming movement under the water but cannot effectively raise their heads to breathe.”
One risk associated with all childhood swimming lessons is the possibility that parents will become complacent about water safety. Drowning happens quickly and silently, and parents and caregivers must be vigilant no matter how good a swimmer a child is. The AAP warns that “swim programs should never be seen as “drown proofing” a child of any age.” Any language on a swim program that suggests that should discredit them. IN general, caregivers supervising inexperienced swimmers should never be more than an arms-length away, and practice what’s called touch supervision.
When it comes to kids and water safety, drowning prevention strategies must be multifaceted. Swim lessons are just a start. Supervision, swimming skills, coast guard approved life jackets and non-inflatable floaties, four-sided locking fences around pools, and safety alarms are all important aspects of the same system. Lessons are only a part of the equation. “One thing is never going to be enough,” Hoffman says.