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Bone Considerations in Young Divers
by DAN Medical Team on June 23rd, 2016

​Our 12-year-old daughter has shown a great deal of interest in learning to dive and as a family, we have just experienced an introductory dive at our local dive shop. At our daughter’s recent physical exam, her pediatrician expressed some concern for her bone growth and scuba diving. It seems there are many youngsters involved in diving. Should we be concerned for our daughter’s growth and development if we decide to allow her to dive?
​In general, the concern is focused on the possible formation of micro-bubbles in the bloodstream of all scuba divers. We often call these ‘silent bubbles’, which fail to produce any detectable symptoms, but are known to be present in the bloodstream of many divers. No one knows to what extent these bubbles could form in younger divers. Theoretically, these bubbles may obstruct blood flow in nutrient vessels to the epiphyseal plates, also called growth plates. This process may cause focal areas of avascular necrosis or angular deformity to the developing weight bearing long bones, particularly the femoral head, distal femur, and proximal tibia

Young divers should stay within the guidelines of the junior divers program. This will limit their exposure to nitrogen, by restricting depth, time and number of dives as well as allowing for maximum surface intervals to promote nitrogen off gassing. Although the concern is theoretical, conservative dive practices are recommended for junior divers.

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Russ Davies - October 13th, 2016 at 2:52 AM
Hi, I found your reply to "bone growth in young divers" a bit scary for the parent concerned. The examining pediatrician did realise there may be complications for young scuba divers. Perhaps a referral to a "pediatrician dive doctor" could have been mentioned?
Peter Southwood - October 13th, 2016 at 3:59 AM
Where will you find a pediatrician dive doctor? There is no such specialisation. Even if you were to find a pediatrician who was also a diving medical specialist, that wouldn't make them a specialist in diving medicine for children. The whole point of the article is that there is insufficient data to reliably predict whether there may be problems or not, and that children should not be used as experimental subjects as they cannot legally give informed consent.
The DAN Team - October 17th, 2016 at 5:11 AM
We are pleased that you took the time to comment on the blog post. However we feel that your comments will be best addressed in person via our hotline. You can contact the DAN hotline toll-free in South Africa on 0800 020 111 or internationally on 27 828 10 60. Alternatively you can email your contact phone number to the DAN medic on call to
Dr. Jack Meintjes - October 20th, 2016 at 1:47 AM
Both Russ' and Peter's comments are valid. The concern is indeed "a bit scary" and unfortunately we don't have any research studies published on children and this condition. Links have previously been shown with (1) diving depth and (2) a history of decompression sickness and (3) high levels of PAI-1 (a coagulation marker in blood). There are two types of lesions: B-lesions, which are normally not of any orthopaedic significance, and A-lesions, which can cause serious problems at the joint surface - ultimately requiring joint replacement. Joint replacement is a well-defined and frequently-performed operation in adults (whether talking about the hip or shoulder joint). However, the problem with children is that their joint surface is adjacent to their growth plates. In practice, if you have to give a child a joint replacement, there is a risk of losing the growth plate, which is relatively close to the joint surface and likely involved in the pathological process. The advice is therefore to stick to the guidelines of the junior divers programme and to avoid decompression sickness risk (the greatest risk remains the depth-time combination). For more information about the condition, I would suggest you google "dysbaric osteonecrosis". You will notice that it affects quite a high proportion of professional divers...
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