October 29, 2013

Ask the Doctors

Our neighbors are having a swimming pool built, and I worry about my 2-year-old twins. They are very active, and I fear that even though the neighbor’s yard is fenced, they might somehow get in and drown in the pool. What advice do you have?

Drowning is a major hazard to the young. In fact, the World Health Organization statistics of at least 500,000 deaths per year probably underestimate the impact of drowning, as they do not include deaths related to floods, boating accidents, or extreme events such as devastating tsunamis.

Drowning, which is “the process of experiencing respiratory impairment from submersion/immersion in liquid,”1 is the second-leading cause of injury-related deaths among children under 4 years old. The rate of drowning among this age group is about 3 per 100,000 in the United States; in other places such as Thailand, for example, the rate is 107 deaths per 100,000 2-year-old children.

The factors that contribute to a higher drowning rate include being a male, younger than 14 years old, of low education, of poor socioeconomic standing, living in the country, lack of adult supervision, accessibility to water, and—of course—the use of alcohol.2

Persons who suffer epilepsy are at a much higher risk of drowning than others.

When adjusting for exposure and numbers of people involved, the risk for drowning among the general population is about 200 times greater than the risk of being killed in a motor vehicle accident.

One of the best ways to reduce the risk of your children drowning is to sign them up for swimming lessons. Children can learn to swim at a very early age. If taught properly, your 2-year-olds should learn quickly. Now, before summer arrives, is a good time for lessons at an indoor community pool facility.

Young children should always wear life vests when near water, even if they can swim. When our grandchildren visit us at our waterside cabin, we insist that they wear life vests when going outside. 

While one hopes never to need it, certain tips about rescue may be pertinent. Rescue of a person in water may sometimes be safely achieved by tossing them a life belt or other flotation object, or reaching out to them with a pole, stick, branch, or rope. Getting into the water to rescue someone often results in the drowning of the would-be rescuer, unless they know some lifesaving techniques and are good swimmers. A panicked drowning person can be very overpowering.

Conscious people should be brought to land as quickly as possible. The call for emergency medical services needs to be immediate and activated concurrently with all rescue efforts.

An unconscious person may have increased chances of survival if given in-water resuscitation by a highly trained rescuer, but this does not include chest compression, which is futile.

Neck injuries and neck immobilization are not usually concerns in drowning situations, unless diving, water-skiing, surfing, or other watercraft accidents are involved.

Once on shore, place the rescued person flat on their back, with the body and head at the same level. Check for breathing and heartbeats. If the patient is breathing, then place them in the recovery position, which is on their side, the upper leg flexed at the knee, head on its side, and nose and mouth clear of obstruction.

If the patient is not breathing, rescue ventilation is essential. All parents should take a course in cardiopulmonary resuscitation; yet, in drowning situations, sometimes respiratory rescue—mouth-to-mouth breathing—assumes greater importance.

Younger persons resuscitate more easily than older ones. Even successful initial resuscitation may be followed by the need for intensive care, depending on how much water damage has occurred in the lungs.

For readers with older children, we recommend supervised swimming, avoidance of “horseplay” in the water, and lessons in water safety for all children.

  1. E. van Beeck et al., “A New Definition of Drowning,” Bulletin of the World Health Organization 83 (2005): 853-856. 
  2. “Drowning,” New England Journal of Medicine 366, no. 22 (May 31, 2012): 2102-2108.