In 2018, almost 900 US children and youth under 20 years died of drowning and more than 7200 were seen at a hospital emergency department (ED) for a drowning event, with 35% of those children either hospitalized or transferred for further care. Risks related to race and ethnicity are likely related to differences in exposure, behavior, knowledge, and skills. Further research is imperative to learn more about racial and ethnic disparities in drowning and guide effective prevention interventions.
Drowning most often occurs quickly and quietly during periods of inadequate supervision. Adult supervision is often a contributing factor for childhood drowning. Adequate supervisory behavior has been described as being composed of 3 components: proximity, attention, and continuity. It is important to stress that no single intervention is fully protective. Rather, multiple layers of protection are recommended.
The American Academy of Pediatrics (AAP) has revised their prior drowning guidelines report because of new information and research.
Most infants drown in bathtubs and buckets, whereas the majority of preschool-aged children drown in swimming pools. Older children and adolescents are more likely to drown in natural bodies of water.
As opposed to open bodies of water, swimming pools have fewer drowning hazards, such as unknown depths, undefined areas, and presence of currents and waves. However, swimming pools can pose a serious risk to toddlers and young children and older children who do not know how to swim. There are an estimated 6700 pool- or spa-related, hospital ED-treated, nonfatal drowning injuries and 379 pool- or spa-related fatal drownings each year involving US children younger than 15 years, (of these 75% involve children under the age of five).
Portable pools are increasingly popular compared with fixed aboveground pools because they can be set up and taken down or moved to another location with relative ease. Portable pools in residential settings also pose a risk of submersion-related morbidity and mortality to children.
The Consumer Product Safety Commission Recommends all pools, in-ground and aboveground:
It is important to stress that no single intervention is fully protective. Rather, multiple layers of protection are recommended.
Retractable pool covers and pool nets capable of holding the weight of a child have been advertised as effective barriers for drowning prevention. Because these covers must be removed and replaced each time the pool is used, they are less likely to be effective. Active interventions requiring an action each time they are to be used are proven to be less effective than passive interventions, which are always in effect.
Entrapment and hair entanglement remain causes of injury and drowning in the pediatric population. Hair entanglement typically involves girls with long hair who are underwater near a suction outlet. The water flow into the drain sweeps the hair into and around the drain cover, where it becomes entangled in the holes and protrusions of the cover. Other types of entrapment involve a limb or body part. This scenario often involves a child playing with an open drain, inserting a hand or foot into the pipe, and then becoming trapped by increasing suction and resulting tissue swelling. Deaths occur from drowning.
Close, attentive, and constant supervision of young children when they are in or around any body of water is an essential preventive strategy.
Appropriate supervision also includes:
Young children who fall into water often make no noise and can be hard to see below the water surface. Proper care of a young nonswimmer or beginning swimmer requires the supervising adult to be constantly attentive, in close proximity (ie, within arm’s reach) and prepared to intervene.
All children should eventually learn to swim. Swim skill and water competency may be the most important drowning prevention measures in natural water settings because fencing and lifeguarding may be impractical in these settings. The American Red Cross Scientific Advisory Council defines basic swim skills as the following: ability to enter the water, surface, turn around, propel oneself for at least 25 yards, and then exit the water.
In addition to basic swim skills, water competency should include knowledge of local hazards in the aquatic environment, risk judgment and self-assessment of abilities, and recognition and response to a person in distress in the water, including safe rescue and CPR. The AAP supports swimming lessons for children older than 1 year. Swim lessons are increasingly available for children with various disabilities, including autism, or other health conditions.
Preventing boating-related injuries and deaths requires good boat maintenance and function and safe and sober operators and passengers. Parents can teach boating and water safety to their children and prohibit alcohol use during recreational water activities. They can check that the boat operator has had boater education, does not use or allow drug or alcohol intake while boating, has appropriately sized US Coast Guard–approved life jackets available for each passenger per federal law, and will both wear a life jacket and require children to wear them.
All states mandate that all people wear a life jacket when on a personal watercraft or when being towed behind a boat, such as water skiing or water boarding. Life jacket wear rates among people of all ages participating in these activities are greater than 90%. A national law requires that every boat has available an appropriately sized life jacket for each passenger. Almost all states require children to wear a life jacket when in boats; however, the mandated upper age varies from 5 to 16 years.
To stay safe: