Drowning Prevention Is a Team Effort, Pediatricians Say

Drowning remains the leading cause of death among 1- to 4-year-olds, and a multi-layered approach to prevention is necessary, according to a new policy statement from the American Academy of Pediatrics (AAP).

Those methods include functional barriers, effective supervision, water competence, and early rescue and resuscitation of drowning victims, according to Rohit Shenoi, MD, of Baylor College of Medicine and Texas Children’s Hospital in Houston, and colleagues from the AAP Council on Injury, Violence, and Poison Prevention.

Shenoi and colleagues also issued a technical report on prevention of pediatric drowning. Both documents were published online in Pediatrics.

The reports — which include evidence-based recommendations for clinicians, families, community partners, injury prevention professionals, and policymakers — replace previous guidance issued in 2019 and reaffirmed in 2024.

Shenoi told MedPage Today that the new policy statement and technical report are “being released at the start of this year’s aquatic recreation season to remind families of safety strategies they can employ in and around water.”

“Preventing drowning is not the responsibility of families alone,” Shenoi said. “It is a team effort. Pediatricians are in an excellent position to help raise awareness and networking with families, community partners, public health, and injury-prevention professionals along with policymakers to reduce drowning-related injury and death across all age groups.”

In the policy statement, Shenoi and colleagues first addressed water competency and swim lessons.

“Besides being able to swim, water competency also includes being able to anticipate and avoid common drowning situations, perform survival swimming, and recognize and assist persons drowning,” they wrote. The AAP recommends swim lessons after a child’s first birthday, adding that there are no data to recommend infant swim lessons.

Shenoi and colleagues next turned to supervision. “Close, constant, attentive, and competent adult supervision is a cornerstone of water safety when children are in or around water,” they wrote. Research has shown that in 86% of fatal pediatric drownings in kids younger than 14 years, the child had unpermitted access to water, and that 80% of kids were alone and unsupervised for an average of 16 minutes.

Shenoi and colleagues further noted that distractions or concomitant alcohol use by caregivers impairs effective supervision, and that competent supervision requires the ability to implement actions in the drowning chain of survival, such as prompt cardiopulmonary resuscitation (CPR). “Lifeguards provide an additional layer of protection but do not replace adult caregiver supervision,” they reiterated.

In addition to water competency and effective supervision, proven methods of prevention include 4-sided pool fencing with a self-closing and self-latching gate, life jacket use when boating or during recreational water activities, and early rescue and resuscitation of kids who have drowned, the authors said.

Shenoi and colleagues emphasized there are disparities in drowning rates by race and ethnicity. In a national survey, lower water exposure, rates of swim lesson attendance, and swimming skills were observed among Black and Hispanic adults compared with white adults.

Reasons for disparities are multifactorial, Shenoi said. These include “limited access to aquatic activities, fewer community resources and aquatic venues, or restrictive policies pertaining to access, cost or clothing for low-income populations and Black communities that may hinder participation in aquatic activities.”

There are also “fewer opportunities for swim instruction or access to single-sex aquatic settings, fear of drowning, variations in intergenerational swimming capabilities related to historical racist policies which limited access to swimming, prior negative swimming experiences, and shortages of lifeguards in underserved urban communities,” he added.

“Culturally affirming policies that encourage participation of people from diverse backgrounds in aquatic activities, expand access to swim classes and aquatic venues, and disseminate affordable and culturally appropriate water safety information and resources in multiple languages per local needs to people of all ages, cultures, and abilities are important when addressing disparities in drowning death rates,” Shenoi and colleagues wrote in the policy statement.

“Community programs that train lifeguards and staff community pools can reduce disparities in access to safe swimming locations for urban youth,” they added.

Legislation with enforcement is also an “effective tool in drowning prevention,” they wrote. Legislation related to swimming pool fencing, prevention of entrapment injuries in public pools, safe natural water swim areas, and life jacket use among boaters have reduced drowning deaths, they said.

Inspections of aquatic venues to increase compliance with safety regulations or close facilities with safety infractions can be beneficial, they added.