Male toddlers, adolescent boys at highest risk for drowning, AAP warns

Male toddlers and adolescent boys are at the greatest risk for drowning, the AAP warned in an updated technical report.

The AAP said it updated its technical report on preventing drowning to reflect new research in several areas, including populations at increased risk, racial and sociodemographic disparities in drowning rates, and water competency.

The AAP noted in a news release that the report emphasizes that no single intervention — such as swimming lessons or lifeguarding — is sufficient enough to prevent drowning and recommends multiple layers of protection to prevent drowning.

“Drowning is quick and silent — not at all what people might expect — and it can happen in a bathtub, an inflatable backyard pool or hotel pool or beach where lifeguards are on duty,” Sarah Denny, MD, FAAP, lead author of the report, said in the release. “Parents may expect to hear a child splashing or crying if they are in trouble in the water, but often that is just not the case. We do have strategies to prevent these tragedies, which include not only close supervision but putting up physical barriers to prevent children’s access to water.”

The AAP recommendations include:

• Provide close, constant, attentive and capable adult supervision when children are in and around water, and use life jackets.
• In order to prevent unsupervised access to water, four-sided fencing at least 4 feet tall with self-closing, self-latching gates that completely isolate the pool from the house and yard should be used.
• In the home, be aware that infant bath seats can tip over and children can slip out and drown in only a few inches of water. Infants should never be left alone in a bathtub, even for a minute.
• Parents and caregivers should prevent unsupervised access to the swimming pool, open water, or bathtub.
• To prevent drowning in toilets, young children should not be left unsupervised in the bathroom. Toilet locks may be helpful.
• Water should be emptied from containers, such as pails and buckets, immediately after use.

Additionally, the AAP says swimming lessons should begin for children at around age 1 year. However, lessons and skills are essential but are not enough on their own and will not “drown-proof” a child.

“Parents will want to consider if their child is mature enough for swim lessons and talk with the pediatrician if they have any concerns about a child’s physical limitations or health,” report author Linda Quan, MD, FAAP, said in the statement.

Additional findings from the AAP’s review included:

• Drowning is the leading cause of unintentional injury-related death among U.S. children aged 1 to 4 years, and the third leading cause of unintentional injury-related death among children and teens aged 5 to 19 years.
• In 2018, 900 children and teens aged younger than 20 years died from drowning. That year, 7,200 were seen at a hospital ED for a drowning event, with 35% of those children either hospitalized or transferred for further care.
• About 75% of all children and teen drowning victims are male. Teenage boys are 10 times more likely to experience drowning than females, possibly because of greater exposure to aquatic environments, overestimation of swimming ability, higher risk taking and greater alcohol use.Most infant drowning deaths occur in bathtubs and large buckets. Approximately 15% to 30% of caregivers have reported leaving their children younger than age 2 years unsupervised in the bath for a period ranging from one minute to slightly over 5 minutes.
• Children aged younger than 5 years who drown each year often have unexpected, unsupervised access to water, such as a residential pool. About 6,700 children aged younger than 15 years are treated in U.S. EDs for pool- and spa-related nonfatal injuries and 379 die of drowning annually. About 75% of children in both categories are aged younger than 5 years, according to research.
• Drowning rates are higher in Black children and American Indian/Alaska Native children aged 19 years and younger. In swimming pools, Black children aged 5 to 19 years were 5.5 times more likely to drown than white children of the same age. With no physiological differences to explain the difference in drowning risk, experts said poor swimming skills in both children and their parents, lack of early training, and lack of lifeguards at motel/hotel and apartment pools may be important factors.
• Research shows that 70% of drowning deaths among children aged 15 years and younger occur from May through August. One report found that approximately half of drownings occurred between 4 p.m. and 6 p.m., coinciding with the busiest swim times, as well as distractions secondary to meal preparation.

References:

AAP. American Academy of Pediatrics identifies children most at risk of drowning and recommends layers of protection to prevent tragedy. https://services.aap.org/en/news-room/news-releases/aap/2021/american-academy-of-pediatrics-identifies-children-most-at-risk-of-drowning-and-recommends-layers-of-protection-to-prevent-tragedy/. Accessed July 12, 2021.

Denny SA, et al. Pediatrics. 2021;doi:10.1542/peds.2021-052227.