Keeping kids safe in the water

Drowning prevention 101

It was a bright summer day. Four-year-old Dante and his parents were at his aunt’s apartment building for his cousin’s birthday. The birthday party was in the party room, and the kids had all been having a blast in the swimming pool. 

Dante was wearing his floaties and had been splashing in the shallow end with his older cousins. He took them off to use the bathroom. As everyone gathered in the party room to cut the cake, Dante’s mom noticed he was missing. 

Five minutes later he was seen at the bottom of the pool. He was pulseless and unresponsive when he was pulled out. His uncle started CPR. 911 was called, and when the paramedics arrived, they placed a breathing tube, an IV and continued CPR. 

They took him to the Children’s Hospital. After about 30 minutes of CPR, he had a pulse. He was then admitted to the ICU.

Dante’s story is sadly all too common. According to the CDC, every year in the United States there are an estimated 3,960 fatal, unintentional drownings, including boating-related drowning. That is an average of 11 drowning deaths per day.

In addition, there are 8,080 nonfatal drownings. For every child who dies from drowning, another eight receive emergency department care for non-fatal drowning. 

What is drowning?

Drowning is the process of experiencing respiratory impairment from submersion or immersion in a liquid. Fatal drowning happens when the drowning results in death. Nonfatal drowning happens when a person survives a drowning incident with a range of outcomes, from no injuries to very serious injuries or permanent disability.

According to the CDC, children ages 1–4 have the highest drowning rates. Most drownings in these children happen in swimming pools. Drowning can happen anytime, including when children are not expected to be near water, such as when they gain unsupervised access to pools, ponds, or other bodies of water. 

Certain factors make drowning more likely:

• Not being able to swim. Many adults and children report that they can’t swim or are weak swimmers.
• Missing or ineffective fences around water. Barriers such as pool fencing prevent young children from gaining access to the pool area without caregivers’ awareness.
• Lack of close supervision. Drowning can happen quickly and silently anywhere there is water, especially to unsupervised children. It happens in lakes and oceans, pools, bathtubs, and even buckets of water. Drowning can occur even when lifeguards are present.
• Not wearing life jackets. The U.S. Coast Guard reported 613 boating-related deaths in 2019. Of these deaths, 79% were drowning-related, and of those who died from drowning, 86% were not wearing life jackets.
• Using drugs and certain prescription medications can increase the risk of drowning.
• Drinking alcohol. Among adolescents and adults, alcohol use is involved in up to 70% of deaths associated with water recreation, nearly one in four emergency department visits for drowning, and about one in five reported boating deaths.
• Certain medical conditions such as epilepsy, autism and heart conditions are also associated with a higher risk of drowning.

Location of drowning

The highest risk locations for drowning vary by age. Among infants under one year old, two-thirds of all drownings occur in bathtubs. Most drownings happen in home swimming pools among children ages one to four. More than half of fatal and nonfatal drownings among people 15 years and older occur in natural waters like lakes, rivers or oceans.

Drowning and race

According to the CDC, African American and Native American children are more likely to drown than are White children. In swimming pools, Black children ages 10-14 years drown at rates 7.6 times higher than White children. 

Black children and youth are more likely to drown in public pools, and White children and youth are more likely to drown in residential pools. In natural water, American Indian or Alaska Native people have the highest drowning death rates, with rates 2.7 times higher than White people.

These disparities have a historical and current context rooted in systemic racism. The historical denial of access to public swimming pools, the current lack of municipal pools in marginalized communities, and the expenses associated with swimming lessons are some reasons why these disparities persist.

Drowning prevention

• The American Academy of Pediatrics and the Centers for Disease Control and Prevention point to several ways to prevent drowning deaths. These include:
• Teaching school-age children basic swimming, water safety, and safe rescue skills. Learning to swim can reduce the risk of drowning by 88% for one-to four-year-olds who take formal swim lessons. Parents can look for swimming lessons at their local YMCAs or YWCAs. Many communities also offer swimming lessons for children and adults. USA Swimming also has a list of swimming programs available on their website. The AAP recommends starting swimming lessons where children are over 1 year of age.
• Ensuring equitable access to swimming pools and expanding swimming pool access in communities and schools that serve minoritized children. Sports centers like the proposed V3 Sports aquatic center in North Minneapolis will hopefully make swimming even more accessible.
• Strengthen public awareness of drowning and highlight the vulnerability of children.
• Special awareness is needed around open bodies of water like lakes, rivers and the ocean. The water here is usually much colder and there are often currents and waves that make swimming difficult.
• Ensuring close adult supervision whenever children are around water. The AAP and Safe Kids Worldwide, recommend assigning a Water Watcher—an adult who will pay constant attention to children in the water. Close supervision is required when kids are in or near water (including bathtubs), always. Drowning happens quickly and quietly, so adults watching kids in or near water should avoid distracting activities like playing cards, reading books, talking on the phone, and using alcohol or drugs.
• Placing four-sided isolation fences, with self-closing and self-latching gates, around backyard swimming pools can help keep children away from the area when they aren’t supposed to be swimming.
• Learn CPR. These lessons can help save a life.
• Make sure kids wear life jackets in and around natural water bodies, such as lakes or the ocean. Life jackets can prevent drowning during water activities, especially boating and swimming. Life jackets can be used in and around pools for weaker swimmers too.

Swimming is a fun activity and sport that can and should be enjoyed safely by all. We should work towards a society in which all children have an opportunity to learn how to be safe in the water

Dr. Kiragu is an associate of the Children’s Respiratory and Critical Care Specialist’s group and provides pediatric critical care at Children’s of Minnesota. Dr. Kiragu is a passionate advocate for children and is immediate-past president of the MN Chapter of the American Academy of Pediatrics and a past president of the Minnesota Association of Black Physicians. He is an associate professor of pediatrics at the University of Minnesota.