The demand for backyard pools and outdoor activities soared during the pandemic—a reason for optimism as families are looking forward to spending summer outdoors but also a sobering reminder for parents to be extra vigilant about drowning risks.
The American Academy of Pediatrics breaks down the latest research on children in a technical report, "Prevention of Drowning," and finds male toddlers and teenage boys at highest risk of drowning. The report, published in the August 2021 Pediatrics, emphasizes that no single intervention, such as swim lessons or lifeguards, is sufficient and recommends multiple layers of protection to prevent drowning.
A quick and silent killer
"Drowning is quick and silent—not at all what people might expect—and it can happen in a bathtub, an inflatable backyard pool or hotel pool or beach where lifeguards are on duty," said Sarah Denny, MD, FAAP, lead author of the report, written by the AAP Council on Injury, Violence, and Poison Prevention.
"Parents may expect to hear a child splashing or crying if they are in trouble in the water, but often that is just not the case. We do have strategies to prevent these tragedies, which include not only close supervision but putting up physical barriers to prevent children's access to water."
What the AAP report finds
Drowning is the leading cause of unintentional injury-related death in U.S. children ages 1-4, and third leading cause of unintentional injury-related death in children and teens 5-19.
In 2018, 900 children and teens under age 20 died from drowning. That year, 7,200 were seen at a hospital emergency department (ED) for a drowning event, with 35% of those children either hospitalized or transferred for further care.
About 75% of all children and teen drowning victims are male. Teenage boys are 10 times more likely to experience drowning than females, possibly due to greater exposure to aquatic environments, overestimation of swimming ability, higher risk taking, and greater alcohol use.
Most infant drowning deaths occur in bathtubs and large buckets. Approximately 15% to 30% of caregivers have reported leaving their children younger than 2 years unsupervised in the bath for a period ranging from a minute to slightly over five minutes.
Children under age 5 who drown each year often have unexpected, unsupervised access to water, such as in a residential pool. About 6,700 children under age 15 are treated in U.S. emergency departments for pool- and spa-related nonfatal injuries and 379 die of drowning each year. About 75% of children in both categories are under age 5, according to research.
Drowning rates are higher in Black children and American Indian/Alaska Native children age 19 and younger over all. In swimming pools, Black children ages 5 to 19 were 5.5 times more likely to drown than white children of the same age. With no physiological differences to explain the difference in drowning risk, experts believe poor swimming skills in both children and their parents, lack of early training, and lack of lifeguards at motel/hotel and apartment pools may be important factors.
Research shows that 70% of drowning deaths for children age 15 and younger occur from May through August. One report found that approximately half of drownings occurred between 4:00 PM and 6:00 PM, coinciding with the busiest swim times as well as distractions secondary to meal preparation.
Starting swim lessons
"We recommend swim sessions for children beginning around age 1, with the understanding that lessons and swimming skills are essential but are not enough on their own and won't 'drown-proof' a child," said Linda Quan, MD, FAAP, also an author of the report. "Parents will want to consider if their child is mature enough for swim lesson and talk with the pediatrician if they have any concerns about a child's physical limitations or health."
Drowning prevention: have layers of safety in place
To prevent drowning, AAP recommends layers of protection that fall under the categories of personal attention, equipment and water environments. They include:
Close, constant, attentive, and capable adult supervision when children are in and around water as well as life jacket use among children and adults.
To prevent unsupervised access: Four-sided pool fencing at least 4 ft tall with self-closing and self-latching gates that completely isolates the pool from the house and yard.
In the home, be aware that infant bath seats can tip over, and children can slip out of them and drown in even a few inches of water in the bathtub. Infants should never be left alone in a bathtub, even for a minute.
Parents and caregivers should prevent unsupervised access to the swimming pool, open water or a bathtub.
To prevent drowning in toilets, young children should not be left alone in the bathroom, and toilet locks may be helpful.
Water should be emptied from containers, such as pails and buckets, immediately after use.
Children who are under 12 and too young to be vaccinated for COVID-19 should continue to maintain social distance, wash hands and wear masks when in public, according to AAP interim guidance. Children should not wear masks in water.
"It's exciting to see kids outside again, at camp and playing with their friends," Dr. Denny said. "We want everyone to have a safe summer, including time spent making memories at beaches, lakes, and the pool."
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