Aqua Therapy through an Occupational Therapy Lens

What is Aqua Therapy?

Aqua Therapy is a water-based therapy session that allows children to develop essential water safety skills. It also helps improve strength and flexibility, develop body awareness, manage anxiety around water, develop sensory and physical body awareness, develop motor planning, learn to move their body in a new and different way, manage sensory difficulties, develop independence in transitioning to new activities, and increase confidence and play in the water.

Occupational therapists can support children to develop these important skills and learn how to be safe and confident around water. This can help increase children’s readiness for swimming lessons, confidence and safety in play at the beach or backyard pool, develop early learning skills, increase muscular endurance, coordination and strength, balance and body awareness and dressing skills.

Aqua therapy is a perfect forum to work on skills in a play-based, motivating manner. Water play can produce therapeutic benefits for many conditions, including Autism Spectrum Disorder (ASD), Developmental Coordination Disorder (DCD), Cerebral Palsy (CP), Down Syndrome, Global Developmental Delay (GDD), sensory regulation difficulties, hyperactive children and more.

Tips and tricks for teaching water safety

Through using visuals, such as basic pictures of the instruction or action children can begin to develop a visual understanding of what the expectation around the water is. Visuals typically include signs around the pool of ‘no running’, ‘slippery floor’, ‘no diving’. Occupational Therapy visuals can provide more specific instructions such as the use of a social story that outlines the steps of getting ready and getting into the water and instructions for activities. These visuals provide children with a visual representation of what is to come during the session. This can support a reduction of anxiety around a new task, preparation of activities and provide a visual communication method.

Visuals can include; The name and a photo of the OT, a picture of the pool, a picture of their bathers and goggles, a picture of swimming and the day, time and duration of the session.

Another way to support the development of water safety is to slowly introduce children to water across different environments, this can help them become more familiar with water.

Examples; (These recommendations may provide benefit, please do not try all of these simultaneously, or if not suitable for your child, introduce one activity at a time and continue this for several attempts before introducing something new).

  • Set up a water play station where children can explore the sensation of water with their hands and toys.
  • Introducing children to a bath with play toys, including splashing and pouring water over their bodies and their face, when they are ready, blowing bubbles in the bath and into a bucket.
  • If suitable, have children attempt taking a shower to introduce the sensation of water falling over their bodies and face.
  • If possible, take children to the beach, supervised, and play with buckets of water to build sandcastles. Then introduce shallow water play in a safe and supervised area (eg. Running back and forth with the waves, sitting in sandbanks without waves, splashing one another).


How to help support sensory difficulties

It is important to observe and address children’s sensory preferences. These can have a significant impact on everyday functioning and may likely impact children’s ability to participate in activities.

Providing suitable sensory modifications may be necessary for the child at the beginning of aqua therapy sessions or introducing them to water-based play.

Examples include;

  • Earplugs and headband for noise reduction or sensitivities around the ear
  • Goggles for sensitive eyes
  • Comfort toys to support confidence
  • Suitable bathers material tolerable for long periods of time
  • Ensuring the water is warm (when in a controlled environment)
  • Floatation aids to support confidence and stability
  • Holding hands or hugs from therapist or caregiver

Reducing fear and anxiety around water

Fear and anxiety can be common for many children when it comes to water, whether that be having a bath, going to a pool or going to the beach. It is vital that this fear and anxiety is addressed and that children feel supported when having these feelings.
Aqua therapy aims to reduce any feelings of fear and anxiety that may have developed and helps children reduce or overcome these feelings.


Tips to prepare children; (these are recommendations that may provide benefits, however, do not try all of these simultaneously, try each, one at a time)

  • Take small steps, do not expect children to jump in happily immediately on the first day
  • Use a social story of the steps of what is going to happen for visual preparation
  • Practice driving or walking to the area and returning home without going in
  • Practice putting on and taking off bathers
  • Talk positively about water often
  • Show children photos of the location prior