Ask Andrea: How Can I Justify Aquatic Therapy For Peds? My Hospital Doesn't Believe in the Power of the Pool.

Question: My hospital is asking me to justify the cost of aquatic therapy for pediatrics in the face of rising maintenance costs. Help!

Answer: There are hundreds of well supported papers on the benefits of aquatic therapy performed by a therapist for peds patients. I am including just 10 examples below. 

Aquatic therapy, performed by a PT or OT provider, has been shown to benefit various pediatric diagnoses in systematic reviews and meta-analyses.

Here are two meta-analyses from this year which focus on functional participation heavily.

1. Neurodevelopmental Disorders:A systematic review and meta-analysis by Shariat et al. (2024) evaluated the effectiveness of aquatic therapy on motor and social skills as well as executive function in children with neurodevelopmental disorders. The study found that aquatic therapy significantly improved factors related to the Humphries' Assessment of Aquatic Readiness (HAAR) checklist, such as mental adjustment, balance, control, and independent movement, compared to land-based exercises. These improvements highlight the enhanced functional participation of children in aquatic therapy settings.[1]

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2. Cerebral Palsy:A systematic review with meta-analysis by Pauluka et al. (2025) compared gross motor function between aquatic- and land-based exercises in children and adolescents with cerebral palsy. The study found that aquatic physical therapy resulted in higher gross motor function scores than land-based exercises, with a small effect size. This indicates that aquatic therapy can effectively enhance functional participation in children with cerebral palsy by improving their gross motor abilities.[2]

Both these recent studies provide robust evidence supporting the efficacy of aquatic therapy in improving functional participation in children with neurodevelopmental disorders and cerebral palsy.

References

1. Shariat A, Najafabadi MG, Dos Santos IK, et al. The Effectiveness of Aquatic Therapy on Motor and Social Skill as Well as Executive Function in Children With Neurodevelopmental Disorder: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2024;105(5):1000-1007. doi:10.1016/j.apmr.2023.08.025.

2. Pauluka E, Ceolin LS, Fontanela LC, Dos Santos AN. Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/­Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis. Child: Care, Health and Development. 2025;51(1):e70023. doi:10.1111/cch.70023.

And here are another 10 studies which also show significant benefits from aquatic therapy, provided by a PT or OT provider.

1. Cerebral Palsy: Aquatic therapy improves gross motor function, balance, and enjoyment in children with cerebral palsy.[1-2] 

2. Autism Spectrum Disorder (ASD): Multisystem aquatic therapy enhances functional adaptation, emotional response, and social integration in children with ASD.[3] 

3. Neurodevelopmental Disorders: Aquatic therapy significantly improves motor skills, social skills, and executive function in children with neurodevelopmental disorders.[4] 

4. Hemiparetic Cerebral Palsy: Structured aqua-plyometric exercise programs enhance postural control and functional ability in children with hemiparetic cerebral palsy.[5] 

5. Developmental Coordination Disorder: Aquatic therapy improves motor coordination and functional abilities in children with developmental coordination disorder.[6] 

6. Down Syndrome: Aquatic therapy enhances motor skills, balance, and overall physical function in children with Down syndrome.[6] 

7. Spina Bifida: Aquatic therapy improves mobility, strength, and functional independence in children with spina bifida.[6] 

8. Muscular Dystrophy: Aquatic therapy helps maintain muscle strength, flexibility, and functional mobility in children with muscular dystrophy.[6] 

9. Juvenile Idiopathic Arthritis: Aquatic therapy reduces pain and improves joint function and quality of life in children with juvenile idiopathic arthritis.[6] 

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10. Attention-Deficit/Hyperactivity Disorder (ADHD): Aquatic therapy improves behavioral problems, attention, and social skills in children with ADHD.[7] 

These studies collectively provide strong evidence supporting the efficacy of aquatic therapy in managing a wide range of pediatric conditions, highlighting its benefits in improving motor skills, social skills, functional abilities, and overall quality of life.

References

1. Pauluka E, Ceolin LS, Fontanela LC, Dos Santos AN. Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/­Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis. Child: Care, Health and Development. 2025;51(1):e70023. doi:10.1111/cch.70023

2. Lai CJ, Liu WY, Yang TF, et al. Pediatric Aquatic Therapy on Motor Function and Enjoyment in Children Diagnosed With Cerebral Palsy of Various Motor Severities.  Journal of Child Neurology. 2015;30(2):200-8. doi:10.1177/0883073814535491. 

3. Caputo G, Ippolito G, Mazzotta M, et al. Effectiveness of a Multisystem Aquatic Therapy for Children With Autism Spectrum Disorders. Journal of Autism and Developmental Disorders. 2018;48(6):1945-1956. doi:10.1007/s10803-017-3456-y. 

4. Shariat A, Najafabadi MG, Dos Santos IK, et al.  The Effectiveness of Aquatic Therapy on Motor and Social Skill as Well as Executive Function in Children With Neurodevelopmental Disorder: A Systematic Review and Meta-Analysis.Archives of Physical Medicine and Rehabilitation. 2024;105(5):1000-1007. doi:10.1016/j.apmr.2023.08.025.

5. Elnaggar RK, Alghadier M, Abdrabo MS, Abonour AA. Effect of a Structured Aqua-Plyometric Exercise Program on Postural Control and Functional Ability in Children With Hemiparetic Cerebral Palsy: A Two-Arm Randomized Controlled Trial. NeuroRehabilitation. 2022;51(2):247-258. doi:10.3233/NRE-220020.

6. Rohn S, Novak Pavlic M, Rosenbaum P. Exploring the Use of Halliwick Aquatic Therapy in the Rehabilitation of Children With Disabilities: A Scoping Review. Child: Care, Health and Development. 2021;47(6):733-743. doi:10.1111/cch.12887. 

7. Jia M, Hu F, Yang D. Effects of Different Exercise Modalities on Pediatric and Adolescent Populations With Developmental Disorders: A Network Meta-Analysis of Randomized Controlled Trials.  European Journal of Pediatrics. 2024;184(1):18. doi:10.1007/s00431-024-05858-z.