By Dr. Joyce Arpilleda
Every day an average of two children 14 years old or younger die from unintentional drowning. For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries. Nonfatal drowning injuries can cause severe brain damage that may result in long-term disabilities, such as memory problems, learning disabilities, and permanent loss of basic functioning or a permanent vegetative state.
Who is at most risk? Drowning is a leading cause of unintentional injury death worldwide, with the highest rates among children. Drowning is still the leading cause of injury death among children between one and four years old. Children most commonly drown in home swimming pools.
What can increase the risk for drowning? The main factors that affect drowning risk are lack of swimming ability; lack of barriers to prevent unsupervised water access; lack of close supervision while swimming; location; failure to wear life jackets; alcohol use; and seizure disorders. Drowning doesn’t only occur during the summer months; it can happen quickly and quietly anywhere there is water, including bathtubs and buckets. For those with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub the most common site.
To prevent drowning, all parents and children should learn survival swimming skills. Research has shown that participation in formal swimming lessons can reduce the risk of drowning among children one to four years old. Environmental protections such as pool fencing and lifeguards should be in place.
A four-sided isolation fence at least four feet high, separating the pool from the house and yard, reduces a child’s risk of drowning by half. The fence should be hard to climb, e.g., not chain-link, with a self-closing and self-latching gate that opens outward with latches that are out of reach of children. However, even when children have had formal swimming lessons, constant and careful supervision when they are in the water is important.
Alcohol use should be avoided while swimming, boating, water skiing, or supervising children. Alcohol influences balance, coordination and judgment, and its effects are heightened by sun exposure and heat. Life jackets should be used by all boaters and weaker swimmers. All caregivers and supervisors should have training in cardiopulmonary resuscitation (CPR). Seconds count. CPR performed by bystanders has been shown to save lives and improve outcomes in drowning victims. The quicker CPR is started, the better the chance of recovery. In the time it takes for paramedics to arrive, your CPR skills could save a life.
Additional tips to prevent drowning are as follows:
•Designate a responsible adult to watch children while in the bath and all children swimming or playing in or around water.
•If supervising preschool-aged children, you should be close enough to reach the child at all times.
•Because drowning occurs quickly and quietly, adults should not be involved in any other distracting activity, such as reading, talking on the phone, or grilling while supervising children, even if lifeguards are present.
•Always swim with a buddy.
•Select swimming sites that have lifeguards when possible.
•Avoid using air-filled or foam toys instead of life jackets. These toys are not safety devices.
With education and improved behavior, maybe then there will be one fewer injured child.
Dr. Joyce Arpilleda is a physician in the pediatric emergency department at Rady Children’s Hospital-San Diego, an associate clinical professor of pediatrics at UC San Diego and a Fellow of the American Academy of Pediatrics. She can be reached at jarpilleda@rchsd.org.