Drowning prevention: the basics and beyond

Summer is in full swing. Families are enjoying the longer days, the sunshine, the pool parties, and the much-anticipated summer vacations. Seems like everybody relaxes a bit during this time of the year, but let’s not forget that during summertime children spend more time around water and are therefore more prone to accidental drowning and water related injuries. Please don’t let your guard down!

Last summer, I personally witnessed the indescribable, unfathomable pain and suffering a coworker went through as she experienced the unthinkable and unpredictable loss of her toddler, Kaden, to accidental drowning. He was a lively, happy, funny, sweet 2-year-old boy, who enjoyed his food and cuddling with his mommy more than anything else in this world. He loved ducks, stuff animals, and exploring the world around him. He always had a smile on his face. It was heart wrenching to watch his parents, his family, and the community grieving his death.


You might wonder why children drown. Whose fault is it? The reality is that parents across the board do the best they can to keep their children safe, but unfortunately this tragedy could happen to even the most responsible and attentive parents out there. It could happen to anyone!

I have always been an advocate for water safety, but this experience opened my eyes to the fact that as a pediatrician, I should be doing more to educate parents on water safety and hopefully prevent another death. It became evident that this is a conversation I should be having with each one of my patient’s parents. Occasionally, when I mention water safety to parents, I can tell by the look in their eyes that they are wondering…Is she doubting my parenting, my abilities, or even my common sense? It is not about doubting parents, it’s about prevention!

Five facts about drowning you must know:

  1. Drowning is the leading cause of injury-related death in children 1 to 4 years old. Toddlers ages 1 to 3 are the age group at highest risk. Most infants drown in bathtubs and buckets, while preschoolers commonly drown in swimming pools.
  2. Teens ages 15–19 are the second age group at highest risk of drowning. Most adolescents drown in open bodies of water like oceans, lakes, and rivers.
  3. Most drownings occur while the child is in the care of one or both parents. In most cases, the child has been out of sight for less than five minutes and they were last seen inside the house.
  4. Around 70% of drownings take place when children are not actively swimming, but when they have unanticipated, unsupervised access to water.
  5. Around 1,000 children under the age of 20 lose their lives to drowning yearly in the United States. That’s way too many!
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Why are toddlers and young children at increased risk for drowning?

Young children, especially toddlers, are inquisitive and curious by nature. They love exploring and discovering their environment. Water is inviting, and it looks particularly attractive if there are toys in it. Most toddlers have the mistaken perception that they can float and swim because that’s exactly what they have done before with floaties or life jackets on. Toddlers are mobile, which grants them access to places they could not get to before, lack the understanding of the dangers of water, and usually lack the swimming skills to save their lives. Toddlers are determined, quick, and fearless …that’s a dangerous combination, especially when there is lack of barriers to prevent them having access to water sources.

Why are adolescents at increased risk for drowning?

This age group for the most part can be described as independent, overconfident, daring and believe that they are unbeatable. Based on that description, it’s easy to understand that they could overestimate their level of swim skill and get involved in risky situations. Also, they might want to impress their peers or as a result of peer pressure, they could engage in dangerous situation. Last, they are likely to use alcohol or drugs while swimming or doing water activities.


Five common misconceptions you must know about:

  1. I will notice if my child is drowning:


This is a big one. Parents have the mistaken belief that drowning is a loud, splashy, scream for help type of event. Maybe because movies and cartoons depict it as that. But in fact, drowning is usually silent and happens in a matter of seconds (less than one minute).

2. Most kids drown while swimming:


Like I mentioned earlier, most young children drown during times when they are not actively swimming but when they have unexpected, unnoticed access to water.

3. I don’t have a pool, so my kids are safe right?


Bathtubs, hot tubs, spas, toilets, pails, buckets, wading pools, irrigation ditches, ponds, bird baths, garden fountains are all examples of possible sources of danger for young children. Young children can drown in as little as one to two inches of water.

4. Swimming lessons are not beneficial at a young age.


Swimming lessons can be safely implemented at or around age 1 for most children. Evidence reveals that formal swimming lessons starting at this age are beneficial and can prevent drowning. It would be ideal to find a swimming program that is familiar and comfortable working with this young age group. The most important skill to learn at this very early age is self- rescue or the ability of rolling into their backs to float while waiting for help to arrive.

I personally like the ISR, Infant Swimming Resource, which is a comprehensive swimming program that teaches young children survival skills in conjunction with basic swimming skills. Lessons are taught in a one on one environment daily for 4 to 6 weeks. It teaches young children how to practice self-rescue if they fall into water with clothing and shoes on (both light clothing and winter clothing). As kids mature and get older, this program helps them acquire more water competency and more advance swim skills.

Remember that even if your child has had swimming lessons, there is no substitute for adult supervision.

5. Installing 4-sided pool fencing is enough to prevent drowning.


Even though the presence of 4-sided pool fencing, that is at least 4 ft tall and has self-closing and self-latching gates, is considered the to be most researched and effective strategy to prevent unanticipated access to water, fences by themselves are simply not enough. Don’t get me wrong, fencing is extremely helpful as it prevents more than 50% of pool drownings in young children, but we should consider doing more. Keep in mind that children like imitating their parents and they are always watching us, so it is probable that they will try to open the gate and sometimes they will be successful. That’s why it is important to implement several other strategies in addition to the fence to provide extra protection for the child. The implementation of in-house safety gates, childproof door locks, doorknob covers, door alarms, gate alarms, pool alarms, and weight-bearing, rigid pool covers are extra physical barriers that will help prevent young children from reaching water when unsupervised.


 Strategies to prevent injuries and drowning:

  • When young children are in or around water, direct and persistent supervision by and adult with swimming abilities is imperative. The adult should be actively and carefully watching the children, within an arm’s length distance, and not distracted by other adults, his/her phone/electronics, reading, or drinking alcohol.
  • Young children should wear life jackets when they are in or around water.
  • Children should not be allowed to swim alone or under the supervision of another child or sibling.
  • When older children are in or around water, an adult should be present and actively supervising the children, even if the children are considered good swimmers.
  • Establish specific rules and discuss them with your children. For example; no rough play in and around the pool, no head dunking, no diving, no swimming without adult supervision. Establish consequences for not following the rules.
  • During a gathering or party with friends, it is more likely for you to become distracted. So, consider having a rotating designated adult watching the children which could change every 15-20 minutes. In order to make it more intentional, the designated adult could wear a bracelet, badge, or necklace. If there are going to be too many kids or the adults are worried about becoming distracted during the gathering, consider hiring one or more lifeguards to help the designated adult.
  • Consider formal CPR training for you, caregivers, and older children/teens in the house. Having this skill and knowledge could save a life.
  • Prevent young children from having access to water during non-swim times by creating physical barriers like pool fencing, childproof locks, door alarms, pool alarms and weight-bearing, rigid pool covers. If a child is missing, look in the water/pool first.
  • When visiting friends or family, please inspect their house for any potential water dangers. Look for pools, spas, fountains, ponds etc. If the appropriate barriers are not in place, make sure you have direct, constant eyes on your young child at all times during the visit.
  • When vacationing, before renting a house with a pool, please make sure that the pool is properly fenced, and the gates are childproof. Do extensive research of the property and talk to the owner about other possible water dangers that may not have been listed. Once you get there, extensively inspect the surroundings of the property.
  • Young children and toddlers should never be left alone in the bathroom. Toilet locks should be installed, and the bathtub/spa should be emptied immediately after each use.
  • Water from buckets, pails, and other containers should be emptied immediately after each use. Garden features, such as fountains and bird baths, are beautiful, but not appropriate to have if there are young children in the household.
  • Teens crave independence, but remember you are the parent. Establish specific, well defined rules and consequences for not following the rules. Make sure your teen has had formal swimming training. Teens, just like young children, should not swim alone. Remind them of the dangers of swimming under the influence of alcohol and drugs. Encourage them to wear a life jacket when in a boat, jet ski, or on any watercraft. It is important to know the depth of the water before considering diving, as diving in shallow water can be extremely dangerous and cause serious injuries and even death.

I’m not asking for parents to live in fear, but to be alert, aware, vigilant and present when it comes to their child’s safety around water.

Please help me raise water safety awareness and keep Kaden’s memory alive…share this article with your family and friends.



AAP-Updates Recommendations to Prevent Drowning in Children

AAP publications- Prevention of drowning

Water Safety For Young Children

Healthychildren.org-swim lessons

Healthychildren.org- water safety for teens


AAP-prevention of drowning: updated policy

Disclaimer: The content in this blog is not to be considered medical advice and it is not intended to replace the relationship you have with your primary care provider. If you have specific questions, please contact your physician.