Today, scuba diving is also open to children and various diving organizations offer diving courses for children from the age of 8. In addition to the appropriate equipment, diving also requires specific training and the physical and mental readiness to cope with the risks associated with diving. Panic is an important factor contributing to diving accidents, with drowning being the most common cause of death. Reliable figures are lacking for minors diving. A study has attempted to reduce this knowledge gap.
Child-specific factors
Various physical and psychological factors make children susceptible to diving-specific injuries.
Drowning and panic
Drowning is the most common cause of death in child diving, and panic is an important factor. Panic can lead to dangerous behaviors, such as uncontrolled, rapid ascents, which carry the risk of serious injuries such as pulmonary barotrauma.
Brain development in childhood
During childhood, the brain undergoes significant development, particularly in the prefrontal cortex and amygdala, which are responsible for decision-making, emotional control and danger recognition. This ongoing development means that children may find it difficult to respond appropriately to emergencies underwater, increasing their potential for panic and injury.
Barotrauma of the lungs (pulmonary barotrauma, pBT):
Pulmonary barotrauma is a significant risk for young divers, especially during rapid ascents caused by panic. As a result of Boyle-Marriotte's law, the expanding lung volume during ascent can lead to overstretching of the lung tissue and even pneumothorax and arterial gas embolism (AGE) if the breath is held.
Asthma
Asthma is common in children and can exacerbate the risks associated with diving. Bronchoconstriction (narrowing of the bronchi), air trapping (in the alveoli as a result of bronchoconstriction) and reduced exercise tolerance, which can be associated with asthma, increase the likelihood of pulmonary barotrauma when breathing compressed air even at shallow depths.
Development of the Eustachian tube
The Eustachian tube, which enables pressure equalization in the middle ear, is not fully developed until around the age of 12-13. The shorter and more horizontal orientation of the Eustachian tube makes children more susceptible to barotraumas, especially if there are also polyps (mucosal growths due to chronic inflammation), which are often found in childhood.
Temperature loss
Children lose more heat than adults when diving due to their larger body surface area in relation to their body mass.
Patent foramen ovale (PFO)
PFO, a small opening in the atria that can persist after birth, occurs in approximately one third of the population. Although the PFO increases the risk of decompression sickness (DCS) in adults, the incidence of DCS appears to be lower in children, which may be due to the depth restrictions that apply in children's diving.
The study
In the study, 149 underage diving accidents from the Divers Alert Network (DAN) database (2014-2016) were retrospectively analyzed and categorized according to the most common types of diving accidents such as PBt and DCS.
The most common reason for an emergency call was DCS, but only 16% of these cases were confirmed as DCS. Almost half of the suspected DCS turned out to be purely musculoskeletal problems. Most of the confirmed injuries concerned ear, nose and throat problems (32%). These were all recognized as such before the emergency call. In the majority of cases, children were affected during their first dive.
In 15 cases (13%), PBt was diagnosed, often in connection with rapid ascents due to fear or panic, such as in one case with a panic attack underwater and rapid ascent with breath holding. In other cases, problems with equipment or breath-holding contributed, for example due to a regulator free-flow or over-leading. In two of these cases, arterial gas embolism (AGE) was also detected.
Anxiety and panic play a key role in many diving accidents involving children.
15 % were musculoskeletal problems (e.g. diving equipment that was too large and too heavy) and 8 % were injuries caused by dangerous marine animals.
In several cases, it was difficult to distinguish between “real” diving accidents and the development of symptoms due to fear. For example, immersion pulmonary edema was suspected in one emergency call. In the end, however, the case turned out to be a panic attack as a result of overstraining and poor visibility in a beginner. In another case, the coastguard had to respond to a suspected DCS. Ultimately, however, the case was judged to be a hyperventilation attack.
Conclusion
In summary, ear and paranasal sinus barotraumas are the most common injuries in underage divers, especially inexperienced divers. Pulmonary barotrauma (PBt) is more common in this group than decompression sickness (DCS), demonstrating that minors are at significant risk of injury despite less provocative dives.
Fear and panic play a central role in many PBt cases, as the psychological immaturity of minors can lead to poor decision-making and panic underwater, which in turn favors rapid ascents and injuries. Minors face specific challenges when diving compared to adults, including limitations in executive functions, stress response and physical abilities. The psychological immaturity of minors can lead to poor decisions and panic underwater, resulting in rapid ascents and PBt.
Children with ADHD (attention/hyperactivity deficit disorder), who have difficulty focusing, should be mentioned here in particular. In addition, they are often under medication (e.g. Ritalin), the effect of which is unknown under overpressure conditions.
Close supervision, good training and careful assessment of the psychological maturity and suitability of minors for diving are required, as well as special training for diving instructors in order to adequately support the special needs of minors.nderen Bedürfnisse junger Taucher vollumfänglich berücksichtigen zu können.
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