Danger Below the Surface: Identifying Where Children Drown

From the WebMD Archives

July 2, 2001 -- Summer and swimming go together as naturally as peanut butter and jelly. But with the fun comes responsibility, and even danger. Each year in the U.S., hundreds of kids drown, many of them needlessly.

A new study in the July issue of Pediatrics tries to help prevent children from drowning by discovering where they are at greatest risk.

"What we were most interested in ... was providing national data about the types of waters in which children were drowning, in specific age groups, to help guide intervention strategies," study author Ruth Brenner, MD, MPH, tells WebMD. Brenner is an investigator with the National Institute of Child Health and Human Development, in Bethesda, Md.

Brenner and colleagues examined 1,420 death certificates of childhood drownings in 1995 in the U. S. Of those deaths, 47% occurred in freshwater, the most common sites being rivers, creeks, lakes and ponds; 32% died in swimming pools; 9% died in domestic sites (bathtubs and buckets); 8% were unspecified; and 4% died in salt water.


"We then looked at drownings by age groups and, in general, infants were most likely to drown in domestic sites, particularly bathtubs; toddlers in swimming pools; and older children in natural fresh waters," says Brenner.

There were, however some unexpected findings. "We also found that a sizeable proportion, about a quarter of those drownings among [1-4 years old], were in freshwater sites like ponds and rivers," says Brenner, debunking the notion that children under four are mainly in danger around pools. "And among adolescents, particularly among black males, there was a fair number of drownings that were occurring in swimming pools."

In fact, black adolescent boys over the age of 10 were 12 to 15 times more likely to drown in a pool than white boys of the same age. "From our data, we really can't say why," says Brenner.

While the study may not reveal "why" the drownings happened, it does reveal a course of action, according to Brenner. "Overall what this tells us is that we need a multifaceted approach to prevention, that no single strategy is going to prevent all of these drownings because they occur in such a variety of sites even within specific age groups," she says.


Those strategies, according to a 1993 policy statement by the American Academy of Pediatrics (AAP), include:

  • Constant supervision for infants and children when they are in or around any water;
  • Installing four-sided fences with self-closing latches around residential pools;
  • Using personal flotation devices when riding in a boat, fishing, or playing near a river, lake, or ocean;
  • Teaching children never to swim alone or without adult supervision;
  • Teaching children, especially teens, about the dangers of alcohol and drug consumption during aquatic activities;
  • Stressing the need for parents, caretakers, and teens to learn CPR;
  • Teaching all children aged 5 and older how to swim;
  • Prohibiting children under 16 from operating a personal watercraft.

"Kids and water really spell potential danger. Just because a child may have learned to swim does not mean they are drown-proof. That is still a misconception among parents," Gary Smith, MD, DrPH, tells WebMD. Smith is the director of the Center for Injury Research and Policy at Children's Hospital at Columbus, Ohio, and a member of the AAP's Committee on Injury and Poison Prevention.


"Really through the teenage years you need to have supervision of children around water," says Smith, adding that there is no magic age when a child automatically should be allowed to be on his or her own. "It depends on maturity, strength, ability to think through a challenge, and coordination."

"Each of these drownings is a tragedy, and for the most part they are largely preventable," says Brenner. "With some precautions and some increased awareness of the risks that any body of water presents, we can go a long way towards preventing these tragedies."

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