Not a lot of research has been done on the effects of diving on children and guidelines for adults cannot be directly transferred to children. In 2015 researchers Cilveti, Osona, Peña, Moreno and Asensio published a paper titled: ‘Scuba diving in children: Physiology, risks and recommendations’ where they compiled a summary of research done as well as explored some of the risks and recommendations for child-divers.
The researchers found a number of anatomical and physiological characteristics of children that should be taken into account in diving.
The increased pressures experienced while diving affects the respiratory system. Using compressed-air tanks increases the effort required for breathing as larger amounts of higher density air is breathed. Both inhaling and exhaling becomes active instead of being autonomic. Children have smaller airways, creating more effort when breathing compressed-air. This could lead to slower gas exchange and put them at a higher risk of airway collapse. Because children are more prone to getting respiratory infections which leads to higher risks of airway obstruction or trapped air during ascend.
Patent foramen ovale (PFO) has a higher occurrence in children. PFO could lead to nitrogen bubbles entering the circulation system. While there is little research available on PFO and child-divers, adults with PFO are at a higher risk of developing decompression illness. The researchers note that due to these increased risk factors children in diving should adhere to a maximum depth limit shallower than 10 m as micro-bubbles are unlikely to form in shallower depths.
The most common diving accidents in children has to do with their ears. Children’s Eustachian tubes are narrower, shorter and more horizontal. They are also more prone to inner ear infections. This could hinder proper equalising of the airspaces.
Furthermore the articular cartilage (the white tissue found between bones in your joints) in children could increase the risk of developing gas micro-embolisms. Although the researchers admit that there is no researched evidence for this, they argue that higher metabolism and the forming of capillaries in these areas in children contributes to this increased risk.
Diving not only increases the body’s energy consumption, it also exposes divers’ bodies to higher amounts of heat loss. Children are especially vulnerable to this as they generally have a lower body fat percentage than adults.
Most common types of accidents and their causes
According to Divers Alert Network (DAN), 3% of diving fatalities involve children. While most fatalities involves drowning and gas embolisms, other causes include children or adolescent who had not received training and participated in higher-risk dives like deeper dives in caves and wrecks.
50% of child-related diving accidents involved children with asthma who also had a history of anxiety or ADHD, and children who made rapid ascents caused by panic or oxygen exhaustion.
Other causes of accidents include loss of consciousness due to hypoxia (too little oxygen) due to a cessation of breathing while ascending, lunge over expansion injuries, gas toxicity, otic (ear) and dental barotrauma and decompression illness. It is important to note that decompression illness can occur on the very first dive, during shallow dives and eve in swimming pool dives.
Recommendations for scuba diving in children
There are very little studies focusing specifically on children and scuba diving. Thus much of the recommendations are based on experts’ opinions. Generally, any condition that could increase the risk of barotrauma, disorientation, anxiety or the increase or development of comorbid conditions should be assessed beforehand.
Medical conditions that should be taken into account include Ear, nose and throat health, respiratory system health, PFO and epilepsy. While Diabetes mellitus does not necessarily increase a risk in diving, it is suggested that there is adequate glycaemic control and diving with someone familiar with the disease.
The researchers list the following medical conditions as absolute contraindications for diving: sinusitis, acute and chronic otitis media, acute tubal ventilation disorders, asthma (in children under 12) and diseases that involves the narrowing of airways.
From a psychological point of view experts agree that the youngest age to start diving activities is 8 years. Generally children would have developed the ability to co-operate, concentrate, control themselves, have logical thoughts, to take responsibility and have risk awareness at this age. Even then psychological assessment before diving should be thorough and individualised. Here are a few things to take into consideration:
- Children are more easily distracted than adults. This could lead them to increase their depth to see something interesting.
- Children could get excited easily with less awareness of risks. This makes them less predictable, requiring more attentive supervision.
- Children are less able to react to novel and new situations and might find it difficult to handle situation different from those described by their instructors.
- A psychological evaluation should be done at every training stage to ensure that the child is fit to dive.
- ADHD increases the risks of decompression illness and ear and sinus problems. It is advised that children with ADHD do not dive.
- Furthermore it is important to establish that the child expresses a desire to dive and not just following the wishes of their parents or friends.
The researchers also note that dive equipment should be checked regularly to ensure that it is the correct size for the child. Regulators should be light and flexible and lightweight tanks should be used.
Recommendations for scuba diving with compressed air
- It is absolutely not recommended for children under 8 to dive.
- Extreme caution should be taken with child divers between 12 and 16 years.
- Diving should be the child’s decision
- Children should only participate in low-risk dives. Thus avoid night dives, caves and wrecks.
- Shorter dives are advised to prevent hypothermia.
- The recommended maximum depth is 10 meters.
- Children should be accompanied by at leas one (preferably two) experienced adult divers.
Checklist for checking if your child is ready to dive.
It is important to individually assess the risk/benefit ratio.
- Does the child want to go diving (or do their parents or peers want them to)?
- Does the child fulfil the medical requirements?
- Does the child know how to swim? (At least 25m without equipment).
- Is the child capable of listening and understanding?
- Is the child capable of following rules?
- Is the child capable of identifying and interpreting fear?
- Is the child capable of interpreting hypothetical situations?
- Is the child capable of reacting adequately when stressed, scared or frustrated?
- Is the child capable of communicating problems, asking for help and offering help?
- Is the child responsible?
Children often make excellent divers- sometimes even better students than some adults. It is important, however to ensure that your child is both medically and psychologically fit and ready to dive before introducing them to the sport.
*A version of this article first appeared at www.scubadiverlife.com