Drowning prevention calls for multiple safety measures

Sarah A. Denny, MD, FAAP

There isn’t one singular safety measure that should be put into place to prevent drowning, according to new guidance from the American Academy of Pediatrics (AAP), but rather multiple interventions.

Drowning is the leading cause of injury-related death in children, with nearly 1000 deaths in children aged younger than 20 years resulting from drowning in 2017 alone, according to the new policy statement, published in Pediatrics.¹

The new policy statement was developed as a collaboration between the AAP and families who have lost children to drowning, says Sarah A. Denny, MD, FAAP, clinical professor of Pediatrics at The Ohio State University, Columbus, Ohio, attending physician in Emergency Medicine at Nationwide Children’s Hospital, member of the AAP’s Council on Injury, Violence, and Poison Prevention, and lead author of the report.

Risks by age

In the policy statement, risk factors are identified by age, noting that infants most often drown in bathtubs and buckets, whereas pools are the larger risk for preschoolers. In these cases, a lack of physical barriers or supervision most often contributes to drowning, with the report noting that 69% of children aged younger than age 5 years were not expected to be near a pool when a drowning incident occurred.

“While supervision is an essential layer of protection when children are expected to be in or around the water, barriers must be in place to prevent unintended access of children to water during non-swim times,” the policy states. “Drowning is silent and only takes a minute. Those children with highest drowning risk are aged 12 to 36 months. Developmentally, they are curious and lack the judgement or awareness of the dangers of water.”

Teenagers aged 15 to 19 years are the second-highest risk group, the report notes, with this population making up half of the drownings that occur in natural bodies of water. For teenagers, the highest risk comes from an overestimation of skills, participation in high-risk behaviors, and substance abuse, the report notes.

A number of medical conditions also can play a role in drowning risk, the policy states. Underlying medical conditions such as seizure disorders, autism, and cardiac problems can increase the risk of drowning, and parents of children with these conditions should be made aware of their increased risk and prevention strategies.

Prevention strategies

The policy goes on to outline a recommendation for multiple layers of protection to prevent drowning. The first is swim lessons, which the policy notes can benefit children aged older than 1 year, not just in terms of competency in the water but also in awareness of the risks and hazards water can present.

Physical barriers also are key in preventing drowning, with 4-sided pool fencing at least 4 feet in height with self-closing and self-latching gates being the most effective, preventing more than 50% of deaths in the drownings of young children. Pool alarms are another option. Life jackets are an effective physical tool to prevent drowning, as is cardiopulmonary resuscitation (CPR) training for those attending to young children in water settings. This goes hand-in-hand with the recommendation for appropriate supervision of children in the water, which also includes the presence of a lifeguard when possible.

The policy recommends that, as an overall guide, the “Drowning Chain of Survival”¹ should be followed to reduce mortality, and this includes prevention of drowning, being able to recognize distress, providing floatation, removal from the water, and being able to provide appropriate care.

Water safety as the top priority

Although pediatricians have a lot to cover in well-child visits, Denny says addressing water safety should be a top priority.

“Drowning is a leading cause of death in children and can be prevented. Assessing drowning risk and providing the appropriate water safety anticipatory guidance is important at every well-child visit,” Denny says. “The risk of drowning varies by age, geographic location, underlying diagnoses, and so on, so it is important for pediatricians to know these risks and to counsel families accordingly.”

Whereas not much has changed in this policy statement compared with previous guidance, it places more emphasis on how prevention strategies may differ when a child is expected to be in water compared with when they are not.

“When a child is expected to be in and around the water, attentive adult supervision, swim lessons, and life jackets are proven prevention strategies,” Denny says. “However, when a child is not expected to be around the water, barriers are the most effect means of drowning prevention. Four-foot, 4-sided, isolation fencing that separates the pool from the house and the yard with a self-closing and self-latching gate is the most effect barrier to prevent drowning.”

The updated policy also highlights the need to have additional preventive measures in place for high-risk groups, Denny says.

“This policy statement calls attention to groups at high risk of drowning, including toddlers, adolescents, children with autism spectrum disorder, epilepsy, and certain cardiac arrhythmias and outlines the importance of water competency as a family activity,” Denny says. “Parents and children should be water competent, to include water safety knowledge and attitudes, basic swim skills, and how to respond to a swimmer in trouble. Parents should understand that swim lessons do not ‘drown-proof’ a child, and that constant, attentive, and capable supervision with a ‘water watcher’ is an important layer of drowning prevention, even if the child has had swim lessons.”

Denny says she hopes the new policy will increase awareness about drowning prevention among both pediatricians and the general public, as well as provide education on prevention strategies and guide clinical discussions at well-child visits to ultimately decrease the prevalence of child drowning.

References:

1. Denny SA, Quan L, Gilchrist J et al; Council in Injury, Violence, and Poison Prevention. Prevention of drowning. Pediatrics. March 15, 2019. Epub ahead of print. Available at: https://pediatrics.aappublications.org/content/early/2019/04/15/peds.2019-0850.long. Accessed April 23, 2019.