How to Prevent Drowning

As summer continues in North America, and for anyone who goes near the water during any time of year, prevention of drowning is very important. The American Academy of Pediatrics (AAP) takes its responsibilities on this issue seriously, and in 2010 issued a policy statement on prevention of drowning. This is a remarkable and well-thought out document that addresses all of the important issues associated with risk for and prevention of drowning. The online version of the policy statement, along with updated information and services, is available on the web.

The document points out that, historically, drowning has been the second leading cause of unintentional death in individuals aged one to 19 years, causing more than 1,100 deaths per year in the United States alone. 

The AAP defines drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” It does not imply any particular outcome. Persons may “drown” and survive. The categories of outcomes include:

• death
• no morbidity
• morbidity (moderately disabled, severely disabled, vegetative state/coma, and brain death)

There is a discussion of entanglement in drains, particularly in females who are underwater with long hair near a suction outlet. Inflatable pools pose a particular hazard if they are not fenced.

The AAP has previously taken the stance that children are not developmentally ready for swimming lessons until after their fourth birthday. They based this opinion on factors including:

• lack of data to determine whether or not infant and toddler aquatic programs affected the incidence of drowning
• the possibility of a parental false sense of security leading to inadequate supervision of children
• evidence that swimming skills developed at an early age do not achieve proficiency
• inappropriate reduction of a child’s fear of water

Following a recently published report from the Eunice Kennedy Shriver National Institute of Child Health and Development that concluded that swimming lessons do not increase the drowning risk in children aged one to four years, and that they may actually provide a reduction in drowning risk, the AAP is relaxing its stance. However, the AAP emphasizes that lessons, alone, should not be relied upon to prevent drowning, but should be part of a comprehensive injury prevention approach.

Useful approaches to prevent drowning include:

1. Parents and caregivers should never leave small children alone or in the care of another young child while in bathing tubs, pools, spas, or wading pools or near irrigation ditches or other open standing water.
2. Water should be emptied from containers, such as large pails and five-gallon buckets.
3. Never leave children alone in the bathroom. Bath seats are not reliable protection because they can tip over and children can slip out of them.
4. When children are in or around water, a supervising adult with swimming skills should be in the water within an arm’s length. The supervising adult should not be distracted in any way. The supervising adult should know how to swim, perform a rescue, initiate CPR and call for help.
5. Pools should be drown-proofed to the best extent possible, including four-sided fencing that is at least four feet high and climb resistant. The distance between the bottom of the fence and the ground should be less than four inches. The gate should be self-latching and self-closing.
6. Supplemental pool alarms and rigid pool covers should be considered, but are not substitutes for fencing.
7. Pool and spa drains should be evaluated for risk of body and hair entanglement and remedial measures taken, if needed, to prevent adverse events.
8. Children should be taught how to swim, particularly if they are four years of age or older. However, swimming lessons do not provide “drown proofing” for children of any age.
9. Telephone and rescue equipment approved by the U.S. Coast Guard should be at poolside or within rapid reach near any swimming situation. This equipment includes items such as life buoys, life jackets, and a reach tool.
10. Parents should be cautioned not to use air-filled swimming aids such as inflatable armbands in place of personal floatation devices (PFD: e.g., life jackets).
11. All children should be required to wear an approved PFD whenever riding in a watercraft. Small children should wear PFDs when they are at water’s edge, such as along a riverbank or on a dock or pier.
12. Jumping or diving into water can result in injury, so parents should know the depth of the water and the location of underwater hazards before permitting children to jump or dive.
13. The first entry into any body of water should be feet-first.
14. Open bodies of water chosen for swimming should have lifeguards.
15. Swimmers should know what to do in case of rip currents, surge, large waves, and other water hazards.
16. Children should avoid walking on risky (weak or thawing) ice on any body of water.
17. Children with seizure disorders need to be supervised by an adult while swimming or taking a bath.
18. Teens should fully understand the increased risk for drowning if they drink alcohol or use drugs that alter their mental status.