Kids and Diving

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Remora

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Hey Doc!

I have done some research on this, however I thought I would solicit other opinions on this subj. At what age (if any) is it deemed medically safe for children to take on Scuba as a sport. Bearing in mind that some agencies have put depth limits on age. I would think that if the human body's growth/development is affected at 2 ATM the same effect would be present at 1 ATM. Any thoughts or references would be appreciated.
 
Dr Deco may be able to answer this better, but my understanding is there are two factors. First, and probably most critical, is a maturity factor emotionally.
Decisions made during a dive potentially affect the rest of your life and the duration of your life. There is a lower limit of maturity below which you can't expect a child to have the capacity to make lifelong choices. Thus, the requirement to be age twelve or higher.
Below age twelve, society generally recognizes persons as children rather than adults in terms of their ability to make adult decisions and understand the consequences of their actions.
The second has to do with research suggesting that the growth plates of immature skeletons are more prone to osteonecrosis and hyperoxic injury.
That is the basis for some of the 50 to 60 foot depth limits recommended for junior divers.

There may be children below age twelve with the maturity to dive and handle problems and accidents well, but the certifying bodies won't endorse it and I wouldn't recommend it. I have a son who was certified at fourteen and a daughter who was certified at twelve. They have done well, but I now look back on it and wonder if I wasn't pushing the limits of good judgment. (This was before the Junior Certification)
I don't think I'd do the twelve year old again today, knowing what I now know.
John Reinertson
 
Doc

Part 1 need not apply to children/adolescents only but could well apply to some adults as well! The maturity factor is best left to the Instr and parent to decide if the young person is ready.

It was part 2 that I'am most interested in. I have a 17 year old girl whom I certified at age 15. I waited until age 15 because of the points you outlined in part 1. I now have a 10 soon to be 11 year old boy who has the physical capability to dive and I believe the mental maturity to take the first step (he now accompanies me on pool sessions). RSTC rules have changed and most mainstream affiliations have lowered the age to 10 for the entry level crses. Max depth limit is 40ft and must dive with a certifed parent. 12-15 max depth is 60ft and must dive with a certified adult.
This statement is what I am interested in<<The second has to do with research suggesting that the growth plates of immature skeletons are more prone to osteonecrosis and hyperoxic injury>> Can you expand on this or provide some ref I can follow up on.

Tx
 
Children divers should use dive profiles which minimize risk for decompression sickness to eliminate concern for injury to growing tissues, such as the growth plates of bones. There are no good studies that indicate that the growth plates (epiphyseal plates) are a particular problem -- just supposition that an area of increased vascularity "might" be more susceptible to bubbles. There are good animal studies that show that the pressure changes and weightlessness of space cause changes in the growth plates of rats; and, there are studies that show a reversal of the growth process when direct 'expander' pressure is applied to bone but there are no human studies ( and there will never be any ) that show changes in teens.

Since the damage that can be done to bone is in direct proportion to the length of time at depth, it would appear that these factors should be restricted in the growing teen-ager who has a life-time of diving ahead. Arbitrary depths and times have to be chosen to maintain low levels of onboard nitrogen; carefully monitored ascent rates with safety deco stops are definitely suggested.

Also, the 25-30% of incompletely closed PFOs in all children need to be kept in mind when deciding whether or not your child should dive. This figure may even be higher in the younger teens (possibly into the 50-60% range) if some figures of open PFOs are taken in to account from pathological mortality studies. What effect bubbles crossing the PFO into the arterial circulation would have on the child generally (brain, spinal cord as well as bone) is something that is quite troubling to me. All of my children (3) were certified before age 13. I believe that I would wait until at least age 15 at this time. A highly qualified friend of mine, a NAUI instructor/PhD, will not certify until age 18.

The bottom line is that we just don't know (and won't know) - so why take a chance with the future of your family.
 
Thanks for the very informative response. I have always believed that diving must have some kind of negative affect on developing bone and muscle tissue, however it was not clear why. I realize that studies have niether proven or disproven this in the human body but elementary data would support the "no dive option" until a litle older age. Although I was aware of the PFO issue I for some reason did not think of it. I thank you for bringing this up. Looks like the young fella is relegated to the pool for a few more years! This is excellent information which I will ensure every parent is aware of prior to enrolling their child on a course.

Thanks again
John
 
All respondents gave very good answers to a question without clear data. Obviously, a dive situation that could cause the growth of decompression gas bubbles in developing tissue could certainly be imagined as a less than salutary one. This is especially so when one considers that some circumstances may arise that result in a conjunction of events precipitating decompression sickness. The fact that these younger people have organs in the developing state could be imagined to have greater long-term consequences. As mentioned by ScubaDoc, there will not be any research on this issue with humans since purposeful infliction of long-term harm is unethical. Animal studies are generally less than rewarding since the characteristics of bipeds and quadrupeds have pointed to difference in the decompression response.

The PFO issue is a considerable one and concerns vein to artery stoke from gas bubbles. The necessity of screening (and elimination if necessary) of EVA astronauts has lead to long discussions at NASA. There is currently not a resolution of this, and it is believed that the risk concerning DCS can be contained by very conservative decompression procedures. [This depress is from the space craft cabin (14.7 psi) to the EVA suit (4.3 psi).] These situations are always different from the ones concerning recreational diving that is voluntary and unnecessary.

Dr. Wilmshurst in England has studied the PFO issue. In his medical practice, he has examined many divers and has inserted a closure device(Amplatzer® occluder) in the hearts of some commercial divers. This has appeared to help their problem of a reoccurrence of neurological DCS. This is currently in trials in the US and is not available in the United States.
 
Doctors,

Do I understand that certifying a child at the ages that have been set forth by the Certification Agencies clould lead to an onset of osteonecrosis and hyperoxic injury?

If this is the case, then why would anybody in their right mind subject children to this.

I ask this because I have a son that is quickly approaching this age & is in a feaver to get certified. Now he'll just have to wait.

Don
 
To be precise, there are theoretical reasons for the risk to be greater. There are no real data to support or refute it, and the testing can't be done for ethical reasons.
The agencies have come up with limited certifications as a way to allow the SCUBA experience, but with narrower exposure limits. They limit oxygen exposure (by limiting depth) and limit risk of silent bubbling by limiting depth and conservative profiles.
We don't know what the exact risk is. It is probably lessened by conservative diving. Just as other sports carry a risk of injury, so does SCUBA. A parent has to decide, and unfortunately, this particular decision is clouded by a lack of hard data.
For those parents that go ahead with it, I might personally suggest staying very conservative with limiting depth and using slow ascent times.
For those that stay away from it, I fully understand the fear of unknown risks. We all worry about our children.
The only person I would question would be someone who encouraged their child to ignore the limits or dive aggressively.

I hope this clarifies the situation. Dr Deco, please jump in if I've made any misstatements. I'm an amateur at diving medicine.
Dive safe,
John Reinertson
 
There are not any good medical statistics on young divers since there have not been many until recently. PADI has a very extensive program that appears to me to be well thought out with respect to time/depth profiles. One can dive with children and reduce the gas loads as the training agencies suggest. Whether this eliminates all problems, only time will tell.

I probably would not be inclined to let my children dive if they were young. [My youngest was 24 years old when he started diving.] However, as one become more accustomed to the programs, they do appear to be reasonable.
 
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