Drowning can be silent and quick, and it kills nearly 1,000 children every year. To refocus the attention of parents and physicians on one of the leading causes of death among children, the American Academy of Pediatrics is publishing updated recommendations on water safety.
“Drowning is the single leading cause of injury-related death among children ages 1 to 4,” said Sarah Denny, MD, FAAP, lead author of the policy statement, “Prevention of Drowning” published online March 15, 2019, in Pediatrics. “Many of these deaths occur when children are not expected to be swimming or when they have unanticipated access to water. Toddlers are naturally curious; that’s why we must implement other strategies, such as pool fencing and door locks.”
The second age group at highest risk of drowning deaths is teens, said Dr. Denny. Every year, about 370 children ages 10 to 19 drown. “Adolescents can be overconfident in their swimming abilities and are more likely to combine alcohol use with swimming – compounding their risk significantly. Children of color, especially African American teens are especially at risk.”
In the policy statement, the AAP lays out strategies to protect children at each stage of their life. New parents are advised to be vigilant at bath time and to empty all buckets and wading pools immediately. All children should learn to swim, and children and teens should wear life jackets while near open bodies of water. Teens can learn CPR and other water safety skills.
Injury prevention has long been a priority of pediatricians, and public health initiatives over the past 50 years have led to dramatic reductions in deaths from injuries related to motor vehicle crashes, sudden infant death syndrome, drowning, and other unintentional injuries. In the past few years, however, the rate of decline in these deaths has slowed.
Drowning remains the third leading cause of unintentional injury-related death among children ages 5-19 years. In 2017, nearly 1,000 children died from drowning and 8,700 visited a hospital emergency room because of a drowning event – with toddlers and teens at the highest risk.
The topic will be the subject of a panel presentation March 16, when leaders of the AAP will gather in Itasca, Ill., for an annual leadership conference. Family advocates, including Nicole and Jonathan Hughes, and Bode Miller, will share their experiences of losing a child to drowning. The panel will also include Sam Hanke, MD, FAAP, who lost his son to sudden infant death, and parent Greg Schell, chair of the AAP Family Partnerships Network. The panel will address recent trends in preventable child injuries, and how pediatricians can work with families to improve child health.
“We appreciate the chance to partner with these families, who have decided to channel their grief to help other parents prevent a similar tragedy. It is critically important for us to collaborate with families and communities to protect kids from drowning” said Ben Hoffman, MD, FAAP, Chair of the AAP Council on Injury, Violence & Poison Prevention. “Pediatricians should be talking about water safety routinely during well-child visits. But having families share their personal stories, we hope, will help connect with parents who may think it could ‘never happen’ to them. Tragically, it can happen to anyone.”
AAP will also publish new information for families on its website for parents, HealthyChildren.org, including water safety advice based on children’s developmental stages, and recommendations on choosing a good learn-to-swim program.
“Research has found that swim lessons are beneficial for children starting around age 1, and may lower drowning rates”, said Linda Quan, MD, FAAP, a co-author of the policy statement.
“Learning to swim is a great family activity,” said Dr. Quan. “Families can talk with their pediatrician about whether their child is developmentally ready for swim lessons, and then look for a program that has experienced, well-trained instructors. Ideally, programs should teach ‘water competency’ too – the ability to get out of the water if your child ends up in the water unexpectedly.”
Even the best swim lessons cannot “drown-proof” a child, and so AAP strongly recommends parents take steps that make a child’s environment safer. For homes with a pool, the most important safety measure is a 4-sided fence that completely surrounds the pool and isolates if from the house.
AAP also recommends:
- Parents and caregivers should never leave children alone or in the care of another child while in or near bathtubs, pools, spas, or other open water.
- Adults should empty water from buckets and other containers immediately after use.
- Do not leave young children alone in the bathroom. Toilet locks can prevent drowning of toddlers.
- When infants or toddlers are in or around the water, a supervising adult with swimming skills should be within an arm’s length, providing constant “touch supervision.”
- Even with older children and better swimmers, the supervising adult should focus on the child and not be engaged with other distracting activities.
“Water is everywhere, and we need multiple layers to protect children from the deadly risks it poses,” said Dr. Quan. “As pediatricians, we cannot overlook this risk. Pediatricians can help by counseling families and working in their communities to improve safety, especially around pools, lakes and in boating communities.”
©The American Academy of Pediatrics, March 2019. The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.