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Drowning is something that happens quickly, it happens usually insidiously, and [it is] really difficult to unwind the damage from drowning as time goes by, said James Barry, MD, a pediatric emergency medicine fellow in Rochester, New York. It is why the National Drowning Prevention Alliance (NDPA) and the American Academy of Pediatrics (AAP) held a joint virtual panel to discuss drowning prevention strategies this summer.1

According to the Centers for Disease Control and Prevention (CDC), as of May 14, 2024, drowning deaths are on the rise in the United States, with over 4500 deaths reported each year from 2020 to 2022. These figures are 500 more per year compared to 2019. In children aged 1 to 4 years, drowning is the No. 1 cause of death in the United States.2

The best way to explain drowning to anybody is when you're submerged in water, you have this kind of panic response and you start flailing and at some point, you take a breath, said Barry. A breath leads to an aspiration or breathing in of the water, and that can disrupt the way that your body transitions oxygen and carbon dioxide across the lung and it actually disrupts the surface tension of the lungs, so you experience a lot of collapse of the lung. That leads to hypoxemia, or low blood oxygen, which can lead to loss of consciousness or apnea. That leads to bradycardia, which leads to arrest and then you have a lot of pulmonary edema, you can have neurovascular compromise.

Prevention strategies can save lives, which is why it is important that your patients caregivers and family members understand signs and symptoms and how to execute prevention initiatives that are lacking across the country. The CDC stated in a May 2024 report that nearly 40 million adults in the United States do not know how to swim, and over half of adults have never taken a swimming lesson.2

Something that I recommend to parents, even if it's a weekend course, even if it's a day with an EMS team, learning about rescue breathing, learning about basic life support is critical in preventing some of the long-term damage that happens after drowning, said Barry. The quicker that you're able to take care of the patient, the better their outcome will be.

Access to these lessons and courses has played a role in the recent rise in drownings across the country according to the CDC, which stated that self-reported swimming ability can be linked to access based on historical and social factors. Cost associated with swimming lessons or overall availability of lessons in some communities are factors that may have contributed to the 40 million adults who do not know how to swim.2

Disparities have also emerged in the research, as the CDC noted the highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons. The federal agency reported that 63% of Black adults and 72% of Hispanic adults reported never taking a swimming lesson.2

The CDC, NDPA, and AAP remind providers, and caregivers directly, how important basic prevention strategies are, such as fences that fully enclose and separate the pool from the house. They should be at least 4 feet high with self-closing and self-latching gates, according to the CDC.2

It's very important to have a fence around a pool, Barry reiterated. [Wearing a] life jacket at all times in any kind of watercraft [is also important]. A lot of pediatricians do a really good job of this, but it's always important to remind families with intellectually or cognitively delayed or impaired children, [that} they should have a lifejacket on regardless of what body of water they're in. Regardless of who's with them. It's extremely important for those patients.

Drowning rates are significantly higher for children and youth with special health care needs, especially neurodivergent kids and adolescents and those with seizure disorders, said Benjamin D. Hoffman, MD, FAAP, president of the AAP, in a Letter from the President published in May 2024. Building awareness and supporting programs to help address these kids needs can save lives.3

In toddlers, the AAP noted backyard pools present the greatest risk for drowning. Its important to recognize children are entertained by water, and if they can get to water, they will, said Hoffman in a May 2024 virtual panel. And if they get to water when there arent barriers in place to prevent access, tragedy can ensue.1

Treating drowning quickly and robustly is critical after a submersion incident, even if that incident doesnt seem serious.

It's really important for those children to get evaluated if they are having those pulmonary symptoms in the first 8 hours, even if you feel like it wasn't a real submersion, said Barry. I say this to every pediatrician as an emergency doctor, if you have a concern about the child after submersion incident, send them into the emergency department (ED). It's always important to just get that screened chest X ray to see if there's any kind of pulmonary injury to prevent a lot of that compromise later.

When it comes to drowning prevention, it starts with caregivers and parents, as theyre going to be the primary personnel dealing with a submersion incident or water difficulties in general that involve their child.

Its really important to counsel parents on water safety, Barry added. Counsel parents on making sure their children know how to swim, making sure their children know how to put on a life jacket and wear life jacket properly. Its critical to kind of press parents on these skills, these ways to recognize, and these supervision techniques that they should be practicing.

References:

1. NDPA And AAP share life-saving insights on childhood drowning prevention ahead of official start of summer and water recreation season. NDPA. Press release. May 24, 2024. Accessed June 6, 2024. https://ndpa.org/ndpa-and-aap-share-life-saving-insights-on-childhood-drowning-prevention-ahead-of-official-start-of-summer-and-water-recreation-season/

2. Drowning deaths rise in the United States. CDC. Press release. May 14, 2024. Accessed June 6, 2024. https://www.cdc.gov/media/releases/2024/s0514-vs-drowning.html

3. Hoffman B. Warmer weather leads to more drownings; what you can do to keep kids safe. AAP News. May 1, 2024. Accessed June 6, 2024. https://publications.aap.org/aapnews/news/28682/Warmer-weather-leads-to-more-drownings-what-you?searchresult=1?autologincheck=redirected

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With drownings on the rise, prevention conversations with caregivers are crucial - Contemporary Pediatrics