Water Safety – The Children's Hospital of San Antonio Blog

Tracy McCallin, M.D., F.A.A.P, Emergency Medicine

Drowning is the second leading cause of death for children under 14 years of age, and is the leading cause of death from preventable injury in children between 1-4 years. As a pediatrician working in the pediatric emergency department for the past nine years and co-author of the American Academy of Pediatrics (AAP) policy statement “Prevention of Drowning,” seeing even one child who has drowned is one too many. Every drowning is a preventable tragedy, but there is no one way to drown-proof a child. Learning how to create multiple layers of protection is the best way to keep your child safe around the water.

The current pandemic has created new challenges for caregivers and families around injury prevention, especially drowning. Water safety can be even more difficult to navigate with the additional stresses that COVID-19 brings such as working from home leading to distractions and decreased ability to supervise young children. Developmentally, toddlers and preschoolers are curious and are not aware water can be dangerous.

Therefore, the highest risk of drowning is during non-swim times for this age group. The Consumer Product Safety Commission (CPSC) reports 69% of children less than 5 years of age were not expected to be at or in the pool at the time of a drowning incident. Drowning is quiet and typically takes one minute or less – the time it takes to answer the door, grab a towel or become distracted by another child. By the time a parent realizes a child has slipped away and fell into a backyard pool or other body of water, it is often too late.

Caregivers need to remain especially attentive when facing distractions at home during the pandemic. Making sure physical barriers to water are in place can help keep kids safe when supervision is difficult to maintain. Physical barriers with four-sided isolation fencing (at least four feet high) including self-closing and self-latching gates to completely separate the pool from the house is the most effective way to prevent drowning in young children. Draining tubs, sinks and buckets and considering the use of toilet locks can also protect your child from household water risks. Whenever you take your child to a new environment such as a friend or neighbor’s home or on vacation, the AAP recommends doing a walk through to check for bodies of water and what barriers may or may not be in place to protect your child.

When children are expected to be around the water, close, constant, and attentive supervision is a critical layer of protection against drowning. Adults should provide touch supervision within arm’s reach of all children in or near the water by designating a water watcher to this important task. The watcher needs to be free from distraction including talking on a cell phone, social media and alcohol use. For infants and children up to age 6 years, always supervise when bathing and never leave a younger child in the care of an older child.

Another challenge for families during the coronavirus pandemic is limited access to swimming lessons in the community due to social distancing guidelines. The AAP now recommends swim lessons begin at 1 year of age with consideration of your child’s comfort in the water, overall health status, developmental and emotional maturity, and physical ability. However, lessons will likely be more difficult to find in the near future, and parents will need to use other methods to prevent drowning. Also, parents should know the AAP does not recommend swim lessons under 1 year of age because infants developmentally cannot lift their heads well enough to breathe. There is no current evidence that infant swimming programs are beneficial.

The American Academy of Pediatrics recommends swim lessons begin at 1 year of age with consideration of your child’s comfort in the water, overall health status, developmental and emotional maturity, and physical ability.

Other layers of protection to prevent drowning include wearing U.S. Coast Guard approved life jackets when boating and for non-swimmers or young children when in or near water. Parents need to know that teenagers are the group at second highest risk of drowning and should be counseled not to use alcohol, especially around the water, and to always wear life jackets when boating. The AAP also recommends everyone learn CPR and basic swimming skills, as well as swimming at sites with lifeguards, especially for open water recreation.

Besides teaching about water safety, one of my other jobs as a pediatrician is to help worried families understand what drowning is and what it is not. There has been much fear, confusion and misinformation in the media during recent years about something called ‘dry drowning or secondary drowning. Although you have likely read some scary stories out there, let me reassure you there is no such thing as dry or secondary drowning. These are not actual medical conditions and the AAP recommends using the term “non-fatal drowning” to describe a child who did not die from a drowning event.

Current evidence shows children will have symptoms such as trouble breathing or lethargy within one to two hours of a drowning event. Drowning does not occur at a later time in children who had previously looked well. Incidents where a dry drowning death was reported in the media were most likely a coincidental event later thought related to water exposure days earlier. If your child has no problems one to two hours after coughing, sputtering or swallowing water, you can feel reassured they will not develop symptoms of drowning at a later time.

So when do you need to worry if your child has drowned? Based on American Heart Association (AHA) recommendations, if your child needed any type of rescue breathing or CPR at the scene of a drowning event, they should always be taken to the emergency department for evaluation. If your child is having trouble breathing or other serious problems after a drowning, he or she will need to stay in the hospital for specialized care and treatment. However, if your child is looking well with normal vital signs and exam after observation in the emergency department, he or she can be safely sent home and will not suffer a drowning related death days or a week later.

Now that you have read this blog, you have the knowledge to keep your child and other important children in your life safe by using many layers of protection against drowning. Please share the word with others and have a safe summer!

For more information on drowning prevention, please visit the AAP Drowning Prevention Campaign toolkit at https://www.aap.org/en-us/about-the-aap/aap-press-room/campaigns/drowning-prevention/Pages/default.aspx and for helpful articles on water safety go to https://www.healthychildren.org.

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Tracy McCallin, M.D., F.A.A.P, Emergency Physician, The Children’s Hospital of San Antonio

Did you know drowning is the second highest cause of death for children under 14 years of age, and is the leading cause of death from preventable injury in children between 1-4 years? As a pediatrician working in the pediatric emergency department for the past eight years, I treat victims of drowning every year. Seeing even one child who has drowned is one too many. Every drowning is a preventable tragedy, and as a co-author for the recent American Academy of Pediatrics (AAP) policy statement “Prevention of Drowning,” I am spreading the word on water safety to give parents the knowledge they need to keep children safe around water.

Another fact you may not know is that toddlers are at highest risk of drowning during non-swim times. The biggest risk to these young children is unexpected access to water, including swimming pools, hot tubs and spas, bathtubs, toilets, and natural bodies of water. The Consumer Product Safety Commission (CPSC) reports 69 percent of children under 5 were not expected to be at or in the pool at the time of a drowning incident. Developmentally, toddlers and preschoolers are curious and lack the awareness of the dangers of water. Drowning is quiet and can take less than a minute. By the time a parent realizes the child has slipped away and fell into a backyard pool, pond or other body of water, it is often too late.

Physical barriers must be in place to prevent unintended access of children to water during non-swim times. Based on the most current evidence, installing four-sided fencing (at least 4 feet high) with self-closing and self-latching gates that completely separates the pool from the house and yard is the most effective way to prevent drowning in young children, preventing more than half of swimming-pool drownings in this age group. These safeguards are vitally important in preventing access to the water when a parent is distracted by other children, making dinner or answering the phone.

The AAP also recommends doing a “walk through” whenever you take your child to a new environment such as a friend or neighbor’s home or a vacation rental, to check for bodies of water and what barriers may or may not be in place to protect your child.

Close, constant, and attentive supervision is a critical layer of protection against drowning when children are expected to be around the water. Adults should provide “touch supervision” within arm’s reach of all children in or near the water by designating a “water watcher” who will take on this task. The watcher needs to be free from distraction including talking on the cell phone, social media and alcohol use. For infants and children up to age 6 years, always supervise when bathing and never leave a younger child in the care of an older child. Remember that children can drown in less than one minute in two inches of water or less; the time it takes for a parent to answer the door, check on dinner or get a towel. Parents should also know that teenagers are the group at second highest risk of drowning, and should be counseled about alcohol use around the water and life jacket use when boating.

Another strategy that may decrease drowning risk, which is now recommended by the AAP, is swim lessons beginning at 1 year of age. The decision of when to start swim lessons must be personalized for each child, considering your child’s comfort in the water, overall health status, developmental stage, emotional maturity, and physical ability. The AAP policy statement recommends infants younger than 1 year are developmentally unable to learn the complex movements, such as breathing, needed to swim. While they may show reflexive swimming movement under water, they cannot lift their heads well enough to breathe and there is no current evidence to suggest a benefit of infant swimming programs under 1 year of age.

Other ways to prevent drowning include wearing U.S. Coast Guard approved life jackets when boating and for non-swimmers or young children when in or near water. The AAP advises everyone should have CPR training and learn basic swimming skills, as well as swimming at sites with lifeguards especially for open water recreation.

There has been much fear, confusion and misinformation in the media during recent years about something called ‘’dry drowning” or “secondary drowning.” One of my jobs as a pediatrician doing drowning prevention work is to help worried families understand what drowning is and what it is not. Although you have likely read some scary stories out there, let me reassure you there is no such thing as dry drowning or secondary drowning. These are not actual medical conditions and the AAP recommends using the terms “nonfatal drowning” to describe a child who did not die from a drowning event, and “fatal drowning” to describe a death from drowning.

Current evidence has shown children with a drowning event will have symptoms such as trouble breathing or lethargy within one to two hours of the event. Drowning does not occur at a later time in children who had previously looked well. Incidents where a “dry drowning” death was reported in the media were most likely a coincidental event later thought to be related to water exposure days or a week before. If your child has no problems one to two hours after coughing, sputtering or swallowing water, you can feel reassured they will not develop symptoms of a drowning event at a later time.

So when do you need to worry if your child has drowned? Based on American Heart Association (AHA) recommendations, if your child needed any type of rescue breathing or CPR at the scene of a drowning event, they should always be taken to the emergency department (ED) for evaluation. If your child is having trouble breathing or other serious problems after a drowning, he or she will need to stay in the hospital for specialized care and treatment. However, if your child is looking well with normal vital signs and exam after observation in the ED, he or she can be safely sent home and will not suffer a drowning related death days or a week later.

The best way to keep your child safe around the water is to remember there is no single way to “drown-proof” a child, and multiple layers of protection must be used against drowning. You now have the knowledge you need to keep your child and other important children in your life safe, so please share this information with others.

Also, you can visit the AAP site for parent education at https://www.healthychildren.org to read helpful articles on water safety such as:

Category: Water Safety

Water safety during the COVID-19 pandemic

Keep Your Kids Safe Around Water