Childhood drowning is a topic that many parents would rather not think about. And yet drowning is responsible for more deaths in children ages 1-4 than is any other cause except birth defects. Even in children ages 1-14, drowning ranks as the second leading cause of injury-related deaths, behind only motor vehicle accidents.
According to the American Academy of Pediatrics, for every childhood drowning, four other children wind up in hospital emergency departments with serious near-drowning complications. Making these statistics even more tragic is the fact that drowning is so easily preventable; however, simply telling a parent to “watch your child closely around water” is not enough.
Drowning is defined as the aspiration of water into the lungs, causing suffocation and death. In the past, it was believed that a drowning event required 4-6 minutes of submersion; however, based on pool security camera videos, we now know that drowning can occur in as few as 2 minutes.
Half of all childhood drownings occur at group functions such as school, church or birthday party events, where consistent observation can be challenging. Children who are inexperienced swimmers may attend a pool party where host parents or even trained lifeguards are present. The problem is that there are often minimal clues to indicate drowning, even as the pool is watched closely. There may be no call for help, and no obvious struggle as a swimmer slips beneath the water’s surface.
Frequently, the observed activity may be mistaken for playful behavior. This has been consistently documented by video surveillance.
Lifeguards and parents observing water activities may be distracted externally by other duties, cell phones and social activities. The water surface itself can cause a physical blindness due to reflection and refraction of light. The ripple effect can create the appearance of movement in a submerged but motionless swimmer. Internal noise, such as emotions and distracting thoughts, can lessen attention. Finally, cognitive body blindness is a real phenomenon, where the human eye does not see what the brain wants to deny or disbelieve.
Another frequent but under-reported cause of drowning is shallow water blackout. This is caused by competitive, repeated or prolonged breath holding. It can occur in even the most accomplished swimmers with no warning signs. When the breath is held for a prolonged time period, oxygen levels in the blood drop, carbon dioxide builds up and loss of consciousness can result. Unfortunately, unconsciousness in a swimmer can result in inhalation of water and subsequent death by drowning. Extreme breath holding, even among highly conditioned athletes, is extremely dangerous and should be avoided.
Drowning can also occur due to genetic factors. Inherited medical conditions linked to drowning include Long QT Syndrome. This can result in an irregular heart rate and subsequent unconsciousness, and can be precipitated by breath holding. Seizure disorders also raise the risk of drowning, which is the #1 cause of premature death in those with epilepsy.
To make that sparkling pool as safe as possible and to significantly reduce drowning risk, inexperienced swimmers are advised to always wear a U.S. Coast Guard-approved life jacket when around water. This alone could prevent up to half of all drowning deaths. Pool noodles and other uncertified float devices should never take the place of a life jacket. Finally, parents are advised to accompany and observe their children at pool parties and other functions around water, providing close, active touch supervision. These “layers of protection” can help to ensure a safe and enjoyable time in the water.
Michael Flanagan, MD, is a professor of family and community medicine at the University Park Regional Campus of Penn State College of Medicine. This article contains information presented at the Family Medicine Seminar Series at Mount Nittany Medical Center by Thomas Griffiths, EdD, president and founder of Aquatic Safety Research Group, LLC and former director of the Penn State McCoy Natatorium. Rachel Griffiths, communication director and West Coast representative of Aquatic Safety Research Group, LLC, contributed to research shared in this presentation.