My child is afraid of the water-should we try aquatic OT?
Many kiddos can be fearful of water. They may be afraid to enter the pool, afraid to use the deep end, resistant to submerging under water, or they may even develop nerves related to bath/shower time. However the fear presents, it can be a tricky thing to tackle.
The first thing to keep in mind is, it is not your fault as a parent. Some kiddos just have fears. it is completely normal. And, if you are working with your child to overcome this, then pat yourself on the back and let go of any blame you may be feeling. Fear of water is common and can be overcome. It may just take some time and the right approach.
Most parents want their child to develop comfort in the water so they can participate in leisurely childhood occupations (think birthday parties, beach vacations, etc.). Comfort in the water is also indicative of a very functional and important set of safety skills that children will access their entire lives. But, how can kiddos get to this point if they are too afraid to even go near the water? Can OT help with this?
Do We Try OT?
To determine if OT is the right service to address water-related fears, we must consider two factors…
Does the fear impact other occupations?
What is the underlying reason for the fear?
Let’s talk about why.
What is OT?
An OT’s job is to focus on improving a child’s ability to perform daily activities and occupations with independence, confidence, and self-efficacy. “Occupation” is just a fancy word for describing the activities, roles, and tasks that children engage in each day.
Some common childhood occupations include:
self-care (dressing, toileting, bathing, etc.)
play/leisure
education/learning
social relationships (with friends and familiy)
functional mobility (moving around the house/playground/school independently)
feeding/eating
sleeping
So, if a child is experiencing any type of disruption in their engagement in one or more of these occupations, OT may be a good fit for them! For example, a child may not be able to complete a toileting routine because they have trouble following multi-step instructions. Or, a child may have difficulty engaging in prosocial play with peers because they have a hard time communicating their needs in an appropriate way. In these scenarios, OT is a good fit, as the child is needing to work on specific skills to increase their independence and efficacy in an activity that they are entitled to. It is also important to keep in mind what is expected of your child given their age and developmental level. We wouldn’t expect a 16-month old to complete toileting, but we would expect a five-year old. Your child’s primary care provider, other therapists, or OT can help you to determine what skills are expected according to your child’s age.
Now, let’s bring this back to the water.
Does the fear impact other occupations
In order for a kiddo to qualify for OT services, they need to be experiencing some sort of disruption to their performance in the occupations listed above. If a child is simply afraid of water, but everything else outside of the pool is going great, they probably will not need OT services.
However, OT may be necessary if the fear of water is so substantial that it is limiting their occupational performance. Here are some common scenarios of kiddos who may be a good fit for an OT evaluation.
Consider an OT evaluation if…
the discomfort around water is so extreme that daily hygiene routines are extremely difficult and/or distressing
for example, a child will not bathe because they are afraid of the water
a child becomes dysregulated when they are touching or near water
a child does not even want to touch water
the fear causes significant meltdowns that cannot be soothed
the sight of water alone is distressing
you are avoiding water-related experiences because of the tantrums it will trigger
you do not feel like you know how to help calm your child when they are distressed
the fear is so extreme that your family cannot complete routines/roles that they otherwise would engage in
for example, some families want to spend everyday at the pool. If the fear is preventing this, it may warrant an OT evaluation
or, maybe your child will not play in the sprinklers with their family members
To put it simply, if the fear is bad enough that is shows up in multiple activities and environments, then OT might be a good idea. If you are not sure, your OT will be able to use their clinical reasoning and skilled observation to determine whether or not OT is right for your child. If OT is not the right fit, your OT will be able to provide other recommendations and referrals to try. It may be worth doing an evaluation just to get some more information!
2. What is the underlying reason for the fear?
Another consideration in determining whether or not to try aquatic OT is the reasoning behind the fear. Kiddos can be afraid of water for many reasons. Some common examples include…
they had a negative or frightful past experience with water
they have never had experiences near or with the water and it is unfamiliar
they have observed other peers or adults who' have had negative experiences with water
their sensory processing is irregular, causing…
reduced body awareness in the water
hypo or hypersensitivity to water’s sensations
poor coordination and motor planning in the water
they have a developmental delay that is impacting their confidence to try water-related activities
the have a visual concern that is impacting their ability to engage with water
Some of these concerns warrant an OT evaluation, some may not. During an OT evaluation, the therapist will collect comprehensive information on your child to help determine the underlying reason. If the reason is connected to other sensory or developmental concerns, then OT may be a good fit. Again, you can always request an evaluation to get your OT’s clinical judgement on the matter.
What else can we try?
If your child does not qualify for OT services, here are some other options to consider. The best way to work through water-related fears is by exposing the child to positive, pressure-free experiences with the water. These experiences should be fun, child-led, and void of any pressure for the child to attempt something they do not yet feel ready for. If kiddos are pushed too hard, the fear may intensify.
Here are some positive ways to expose children to the water:
consider swim lessons with a skilled instructor who can adapt to your child’s needs
incorporate water in many forms into daily play
sensory bins with water
use ice to freeze toys
increase play time during hygiene activities
incorporate play and preferred activities near pools/lakes to allow children to watch their peers swim
model enjoyment with water to show your children appropriate ways to interact with it
invite your child to swim one-on-one with you and allow them to enter the pool at their own pace
encourage alternative opportunities to interact with water such as paddle boarding (if old enough), riding on boats, etc.
If you have tried these things and have not found success, it is time for an OT evaluation
If you are still unsure, feel free to contact Aquatics in mOTion. We are happy to talk about your specific concerns with your child to determine if an OT evaluation is warranted.
