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Study: Water therapy helps in the development of preterm infants

Updated: Feb 20, 2020

Translated Article from Ynet, Sept' 2016:

Dr. Hagit Friedman went with her daughter to a post-natal nursery and decided to investigate the effects of water on preterm infants: "Water activity can improve neural development of preterm infants"


Premature birth is often a complex event for parents, and often the start of a different journey of searching for ways which can improve their baby’s health and development. Apparently, water activities adapted to young babies born prematurely can strengthen nervous system functions and promote brain development, according to a new study. The study was conducted by Dr. Hagit Friedman, an expert in the development of the nervous system and a researcher at the School of Social Sciences and Humanities at the Kinneret Academic College and the Department of Nursing at the University of Haifa, Israel.

Dr. Friedman, who conducted the research on a voluntary basis, says: "When my little daughter was born, I looked for a framework for spending quality time with her, and found a baby swim group. During the lessons, I noticed the effect of the water activities on babies and their parents, and as a result I decided to study the subject for about two years, at the end of which I was certified to instruct infant water activities. From there, the research began in cooperation with several departments at Sheba Medical Centre at Tel Ha-Shomer: the rehabilitation pool, the paediatric neurology department and the hospital."

The study has been conducted over two years and involved 46 infants - 23 in the experimental group and 23 in the control group. The method was based on exercises for infants and premature babies, adapted to the developmental stage of the baby. Preterm infants were videotaped before and during water treatment, up to the age of 56 weeks from the date they have been conceived (i.e., up to the age of four months from birth on time). A developmental assessment of the baby was made according to the characteristics of the baby's spontaneous movements as well as other criteria.

The age of the participating premature infants was particularly chosen to be done in this stage in their life, in which the brain has the highest capacity to adapt and change due to its elasticity. This means that with specific stimulations new circuits in the cortex could be established impacting long term developmental abilities.

Significant improvement in preterm conditions

"When we refer to preterm infants, we are talking about the immaturity of all the systems in the body, especially the nervous system that is exposed to the world long before it is ready. Long before it is ready to develop under conditions that are less favourable than in the womb," Dr. Friedman said, “and we have shown that early water activities, especially being carefully tailored, can support and improve the developmental process of preterm infants."

The findings of this study, in these neurodevelopmental tools, suggest that water activity can improve neural development of infants. For example, 80% to 90% of preterm infants who received water treatment improved their neurodevelopmental scores at the end of the intervention period, compared with 20% -30% of premature infants who did not receive water treatment.

For example, a baby who was diagnosed with early signs of cerebral palsy and suffered muscle stiffness and tension in the body. During the treatment of water the stiffness of the muscles decreased significantly and it was possible to promote the development of the baby using various exercises in the water while he experiences enjoyment and does not suffer from pain.

Another child had a tendency to favour one side of the field of vision. Her head was twisted and tilted all the time in the same direction. During the activity in the water it was possible to gently and without resistance or pain and within a relatively short time, make the head turn to the other side as well and operate both sides of the body in a more balanced way.

Another baby ignored his mother's or others' attempts to communicate with him at the beginning of the water treatment period, and towards the end of the period he responded to the environment.

The findings of the study showed that water activity adapted to young infants at risk is first and foremost a safe intervention, which does not increase the risk of health damage or any damage resulting from exposure to water at an early age in infants already at health risk. In addition, the study showed that adapted water activity for young infants can improve neural development of preterm infants.

Optimal conditions for the baby in water

"When the baby floats in water with support, systems that function optimally out of the water, can function better," explains Dr. Friedman, "Breathing, even the nervous system, and even if we do very little, It's very big. Both in the developmental time window and thanks to the properties of the water.”

Does this accelerate the development of these babies?

"I'm not sure it's accelerating, I'm not sure that's what we want, to speed up, it's enough for us to give the optimal conditions for the baby in terms of breathing, in terms of functioning of the nervous system, along with some other exercises that exposes them to situations that because of their young age they cannot yet experience, such as control of movement, and that will already do the job. We're talking about premature babies. This means that their true age is not the same as the age of birth.”

What age do you recommend putting your baby in the water?

"In the study, we took for ourselves a very young bar of 36 weeks of pregnancy, which is already the stage where the spontaneous respiration that is typical of premature babies disappears, so we assumed that it is no longer dangerous to put the baby in the water."

That is, if the baby is born in week 30 or 32 waiting 4 weeks and then starts the treatment?

"By week 36, and then in the NICU, we put them in the water."

And did you see the change immediately?

"We saw the effect in the behaviour and we had several time stations throughout the study in which we examined the development so that there would be identical time stations for all the premature babies."

Do you recommend doing this alone, or only accompanied by a doctor or a professional therapist?

"This study, of course, was borrowed by a developmental neurologist, by doctors and by hydrotherapy professionals, it is important to do it with the accompaniment, to do the right exercises, to do the right follow-up, of course."

So what's the bottom line, your recommendation to parents who are currently having to deal with premature babies?

"To seek the possibility of working with the baby in water from earlier stages."


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