Teaching swimming and water safety skills to children with disability: A systematic review

To evaluate the evidence for swimming interventions for children with disability.

Seven databases were searched for studies of swimming intervention for children with disability (from inception to 2026). Intervention and outcome content, context, and dose were extracted and mapped to Royal Life Saving Australia's National Swimming and Water Safety (SWS) Framework. Results were synthesized according to synthesis without meta-analysis guidelines.

Fifty-five studies (59 papers), that is, six randomized controlled studies, six non-randomized controlled studies, and 43 uncontrolled trials, met the criteria. Most included autistic children (n = 28) or children with cerebral palsy (n = 14) and were delivered by swimming teachers (n = 27), physiotherapists (n = 12), or multidisciplinary teams (n = 6). Interventions included seven of eight Royal Life Saving Australia National SWS Framework constructs, most commonly swimming (n = 51), underwater (n = 40), and flotation (n = 38). Outcomes were measured using standardized (n = 28), custom (n = 21), or swimming speed and distance (n = 3) measures. All studies reported improved swimming, with significant outcomes in 31 of 33 studies reporting significance and medium-to-large effect sizes. Physical (n = 14), social (n = 11), psychological (n = 11), or participation (n = 5) outcomes improved in 29 of 31 studies.

There is low-to-moderate-certainty evidence that swimming interventions improve swimming skills for children with disability, with moderate certainty for autistic children and children with cerebral palsy or developmental coordination disorder. Future research should use rigorous designs that align standardized outcome measures to intervention content and participant skill level and evaluate broader physical literacy and participation benefits.