Children Diving

There is a common belief that while children diving they should not exceed 9 metres depth until their bones have reached osteogenic maturity, i.e. when the epiphyses have fused.

There is very little evidence that DCS or dysbaric osteonecrosis has influenced bone growth in young animals; nevertheless, that possibility leads to some hesitation in contemplating diving in excess of this depth, because of our limited knowledge.

So far, the youngest child to die scuba diving was aged seven years, but there have been many accidents and deaths between the ages of 10 and 15 years.

The most prudent advice to parents is to encour­age children to acquire the aquatic and snorkelling skills at this age, to consolidate the basic capabilities needed later for scuba training.

Official Recommendations

The Recreational Scuba Training Council (RSTC) in the USA has made 15 years the minimum age for certification of sport children diving. This may be reviewed.

The South Pacific Underwater Medicine Society committee on medical standards for recreational diving met in 1990 and considered this subject (diving medical standards). They recommended a minimum age of 16 years for scuba diver training, the decision being based purely on safety factors.

The Australian Standards reduced the recom­mended age to 14 years, to comply with the diving instructor agencies' requirements. The Australian Standard 4005.1 of 1992 stated that the selection criteria required that the trainee shall comply with the following:

• Be at least 14 years of age, but persons younger than this may in some cases be eligible to train for conditional certification which allows the young person to dive with a certified diver, with the consent of parents or guardians.

Under the medical section of the Australian Stan­dards AS 4005.1 it is stated "Children under the age of 16 shall only be medically examined after consul­tation by the doctor with the parent or guardian to establish the child's physical and psychological maturity. Between the ages of 16 and 18 it is prefer­able to consult with the parent or guardian before medically examining the child".

The Australian Surf Life Saving Association, the judgement of which is not influenced by commercial factors but which is very committed to children's involvement, will not allow active life-saving respon­sibilities until the age of 16 years, and even then only under the supervision of a patrol leader, 18 years or older.

Attitudes

The physicians, who are probably more concerned with safety than some instructors, recommend a minimum children diving age of 16 years, with parental informed consent and approval necessary between the age of 16 and 18 years.

Unfortunately, the Australian Standards were not prepared by diving physicians, and although there was a representative present, he was greatly outnum­bered by the industry and diving training organiza­tion representatives. These groups have different agendas, and different motivations to the physicians. There was no one present with pediatric and psy­chological training.

If one looks at the Australian Standards docu­ment, it is implied that even they have some concern regarding the child's safety, until the age 18 years. Off-loading the responsibility to parents who have no practical knowledge of the risks of scuba diving was a reprehensible act.

I am surprised to find that they have accepted an under 14-year-old diver to "dive with a certified diver". This is inadequate, as it allows one young 'conditionally qualified' youth to dive with another diver who may be equally inexperienced.

By analogy, would you allow a 12 to 14-year-old child to:

•     fly an airplane?

•     drive a motor vehicle?

•     take out a financial loan?

•     be legally responsible for decisions made?

•     make medical and health judgements?

•     make life-threatening decisions for himself and others?

If one agreed that 12- to 14-year-old children should be restricted in this way, then it would be interesting to compare this attitude with that of a similarly aged child undertaking scuba diving.

Children Diving Psychological Maturity

This is the main reason why we would prefer not to be give children diving certification. Indeed, cer­tification implies that the diver can make informed judgement as regards dive planning, environmentalconditions, equipment usage, and the interrelation­ships of all these. For a dive to be safe, this judgement is sometimes essential. It is related to maturation and experience, not just intelligence.

A child may have difficulty handling the intellec­tual content of the diving course, but he will have difficulty with its application (abstract thought).

Unfortunately, children do not have the same appreciation of mortality (death) and the implica­tions of morbidity (disease or accidents) as an adult.

Children are more immature - that is what makes a child. They tend to be more immediate in their gratification needs, and have a shorter attention span. They are also not as good at long-term plan­ning as adults. Unfortunately, sometimes the long- term planning will not be needed if the child dies or suffers significant damage.

Materialistic factors also come into play. Children are less likely to abort a dive if they have already committed themselves financially or logistically. Judgement comes with age. Older people see death more clearly.

Psychological reactions are also different in chil­dren who react with behaviour that, in adults, would be abnormal. They are far more likely to display anx­iety or hysterical reactions, and the control of these is part of the maturing process. The appropriate response to a life-threatening situation, or even one that is perceived to be life-threatening, is not to burst into tears. Unfortunately, this is a child's natural reaction, and it is often very successful in obtaining assistance. But tears are not easily seen through a facemask, and in any case, they tend simply to add to the large ocean environment. They do not have the same power under water as they do on land, when the parent(s) is (are) watching.

Children's reactions are certainly rapid, but not always appropriate for long-term health and safety.

Endurance and perseverance are characteristics which develop with age and which take over when panic and tantrums have been controlled. Imagina­tion is an endearing characteristic, but makes kids susceptible to fear and terror.

Children are dependent: they mature slowly to become independent, and act responsibly. Thus they are more likely to rely on the statements and deci­sions of others, as opposed to deciding what they themselves are capable of doing. This might beacceptable on a trip to the zoo, but it is not good when diving in the open ocean, where divers must be self-reliant, recognize their own limitations, and act accordingly. Divers are responsible for the safety and rescue of their companions. Would you really want a 12-year-old child to be responsible for your safety, or your own child's safety?

Children are suggestible and very easily im­pressed. They can be intimidated directly by their parents, and also by the encouragement and enthu­siasm that their parents may give them.

Thus, the child might well continue an activity such as scuba diving, to please mum or dad, to impress their parents and peers and to gain atten­tion, but these are not good motivations for scuba diving. Kids are very easily intimidated, and for the sake of the child, I would prefer to see an indifferent parental reaction than an enthusiastic one.

Children Diving Physical Maturity

The requirement for good-fitting equipment implies the need to upgrade regularly during the growing years.

There is also the likely problem, sooner or later, of the child having to swim against unexpected tidal currents to return to safety. Some children may have this physical ability, but not have the psychological endurance in such an emergency. Others will have neither. A small child might also have great difficulty in coping with the rescue of a larger 'buddy'.

With physical immaturity, there is also the prob­lem of increased dangers from certain diving med­ical disorders, including hypothermia, gas toxicities, susceptibility to marine venoms and barotraumas.

Children Diving Medical Aspects.

The reason that children get 'glue ears' is that their eustachian tubes are narrower and smaller, and so are their sinus ostia and respiratory airways. Chil­dren's upper and lower respiratory passages are nar­rower by comparison to the air cavities associated with them, and that is the reason why children have more trouble with barotraumas in aviation, as well as diving exposure.

Some diseases, such as asthma, are more likely to occur in young children than in late adolescence, when the airways have grown relative to the lung vol­umes. That is why children sometimes seem to 'grow out' of asthma.

Many have questioned the safety of exposing chil­dren to conditions such as pulmonary barotrauma and arterial gas embolism (one cause of acute decompression illness), especially in children where there is still growth of organs, i.e. where a bubble can do more damage than it would in a full-sized adult.

Such tissues that could be so affected include the brain, inner ear, bone and coronary artery. The worry here is that, for the same degree of bubble development, there might be a much greater ulti­mate damage.

Another possible factor increasing the risk of neurological DCS is the patency of the foramen ovale (see Chapter 11). It may close late in childhood and thus have an increased incidence in childhood. This is another reason to limit the dive exposure - to minimize the DCS incidence.

When should children dive?

It is our opinion that a child under the age of 16years should only have 'dive experiences' under thefollowing, moderately safe, conditions:

1    When they want to, without parental or peer pressure.

2    When they are medically fit to do so.

3    That there is a maximum dive depth of 9 metres, to prevent some of the problems referred to above. The 9-metre depth will certainly not pre­vent a child from developing pulmonary baro­trauma, cerebral arterial gas embolism or any of the other respiratory tract barotraumas. It will, however, usually prevent decompression sickness.

4    That they are trained and taken by a qualified instructor, and are under the personal and total control of that instructor (i.e. not three or four trainees together). A buddy line between the child and the instructor is prudent, to prevent uncontrolled ascents.

5    That after this acquaintance dive, all other dives are only to be carried out in calm and good envi­ronmental conditions, and with the same controls

•                    as referred to in points 1-4, with an experienced diver of instructor standard taking absolute control.

•                    Giving a certificate to dive to children under the age of 16 years, other than one which stipulates diving under the above very special conditions is, in my opinion, irresponsible.

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