Water Safety for Children With Autism

Autistic children face a much higher risk of drowning than other children, so water safety needs extra planning. The core of that plan is strong barriers and constant supervision, swim lessons that fit how your child learns, visual supports that teach water rules, and making sure the people around your child know about their interest in water. If your child is ever missing, call 911 and search water first.

None of this is about keeping your child away from water forever. NAA notes that water play is a common favorite activity among kids, especially those with autism (opens in a new tab). With the right support, a love of water can become a real skill and a lifelong joy.

Why water safety needs extra planning

Nearly 40x

That figure comes from a national study of 1,367 deaths of people with autism from 1999 to 2014 (opens in a new tab). It compares causes of death: drowning makes up a far larger share of deaths among autistic people than among everyone else. You may also see "160 times." That figure, for children, came from the lead author's comments in a 2017 Columbia University news release (opens in a new tab); the published paper's all-ages figure is about 40. The American Academy of Pediatrics (AAP) also lists children with medical conditions such as autism and epilepsy (opens in a new tab) among those at higher risk.

Two things drive much of the risk:

• A strong pull toward water. The AAP notes that children on the autism spectrum may be drawn to water and not always recognize the dangers (opens in a new tab). The National Autism Association (NAA) says children with autism will often go straight to water regardless of its temperature or type (opens in a new tab), and that a child who dislikes the bath may see a pond or fountain very differently.
• Wandering. In a national survey of parents, 49% said their child with autism had tried to wander or bolt at least once after age 4 (opens in a new tab); of the children who went missing, 24% were in danger of drowning. In a study of news-reported drownings of children with autism from 2000 to 2017, wandering was the most commonly reported activity before the drowning (opens in a new tab), and about half happened in ponds, on average about 290 meters (roughly 950 feet) from home. (That study looked at 23 incidents, so treat the details as patterns, not rules.)

A home without a pool is not automatically a safe home. Look at the water within walking distance, too.

Supervision and barriers

CDC advises families to take extra precautions around water for conditions like autism (opens in a new tab). The AAP and NAA spell out what that means.

Barriers at home:

• Fence any pool on all four sides with a self-latching gate. The AAP says the fence should completely separate the pool from the house and the rest of the yard (opens in a new tab), and pool doors and gates should be locked and alarmed if possible.
• NAA recommends gate and pool alarms, alarms on windows and doors (opens in a new tab), and visual aids like stop signs on doors, windows and pool gates.
• Cover hot tubs, remove toys from the pool after use, and empty buckets, baby pools and tubs.
• Walk your neighborhood and note every pond, creek, fountain, drainage ditch and neighbor's pool. NAA suggests using a map to identify the water nearest your home (opens in a new tab) and other places your child spends time.

Our interactive audit walks you through the house and yard:

Supervision:

• The AAP says to supervise constantly, even if your child can swim (opens in a new tab).
• NAA advises staying at arm's length without distractions, and warns that more eyes do not equal more protection (opens in a new tab). Assign one responsible person to watch your child for an agreed period, especially at gatherings and in crowds.
• Be extra alert at the times NAA says wandering is more likely: transitions, vacations, holidays, parties, unfamiliar places, new moves, times of stress or noise, daytime co-napping and overnight hours (opens in a new tab).

For door locks and alarms, see stopping children from slipping outside. For pools, see pool fences and gates.

Swim lessons that fit your child

The researchers behind the national autism study wrote that clinicians, parents and social workers should help provide swimming lessons to children with autism as soon as the diagnosis is made (opens in a new tab). The AAP says adapted swim programs reduce drowning risk and can help improve swim competency in children and teenagers with autism (opens in a new tab), and can also benefit motor skills, behavior and mood.

What to look for and ask about:

• Instructors with autism experience. NAA suggests asking your local aquatics center, YMCA or Red Cross provider for lessons specific to your child's needs (opens in a new tab). NAA's Autism Swim Connect (opens in a new tab) is a registry where instructors experienced with autistic children can list themselves so families can find them.
• Real-world practice. For children with autism, NAA recommends that the final lesson be done with clothing and shoes on (opens in a new tab), since a child who wanders in won't be in a swimsuit.
• Skills, not just comfort. Lessons should build the basics the AAP says all children should learn (opens in a new tab): getting back to the surface from underwater, swimming at least 25 yards and getting out of the water.
• Realistic expectations. NAA is clear that teaching your child to swim can help lower risk, but does not eliminate risk (opens in a new tab).

Our guide to adaptive swim lessons has questions to ask a program and how to prepare for the first class.

Visual supports and social stories

Seeing a rule can make it easier to follow. The AAP suggests visual schedules or social stories to help your child prepare and understand pool rules (opens in a new tab). NAA recommends social stories about water safety, trusted adults, safe and unsafe places to swim, and never entering water alone (opens in a new tab), and visual schedules that show when it's time for water play.

Ideas to try:

• A water-time schedule card: "First swimsuit and life jacket, then pool with Dad, then towel."
• A trusted-adult card with photos of the people your child may swim with.
• Stop signs at exterior doors and pool gates, used with alarms, as NAA suggests.
• A home social story. NAA offers a free, customizable story called Staying In My House (opens in a new tab) that you can personalize with your own photos.

Use your child's own way of communicating, whether that's speech, pictures, signs or a device, and practice the same story often, not just before a trip. For general tips on calm, clear teaching, see how to talk to kids about water safety.

Telling neighbors, school and caregivers

You can't watch every door every minute, and you don't have to do this alone. Wandering doesn't only happen at home: NAA, summarizing a 2012 study in Pediatrics, notes that nearly one-third of wandering incidents happened from a school setting (opens in a new tab).

• Neighbors with pools should know about your child's interest in water and your safety precautions, NAA says.
• School and caregivers need your plan in writing. NAA's free Personal Emergency Profile (opens in a new tab) has room for a photo, description, likely places your child may go, likes and dislikes, signs of escalation and medical needs. NAA suggests updating and sharing it at least once a year.
• Babysitters and relatives should get the same rules you use. Print the Water Rules for Babysitters and add your child's specifics.
• Siblings often help and often worry. See supporting siblings of children with disabilities.

Build the full prevention-and-response plan in wandering and water: a safety plan.

What you can do today

1. Map the water. List every pool, pond, creek and fountain within walking distance of home and school.
2. Add one barrier. A door alarm, a high lock or a stop-sign visual on the door your child is most drawn to.
3. Ask about lessons. Call a local pool or YMCA and ask whether they have instructors experienced with autistic children.
4. Make one visual. A water-time schedule card or a short social story with your child's photos.
5. Fill in the profile. Complete NAA's Personal Emergency Profile and share it with school and one neighbor.
6. Put it all in one place with our family water safety plan: