AAP Voices Blog

A child’s drowning is haunting.

Each of us as pediatricians and advocates for children’s health likely can recall personal and professional experiences involving a child who died of drowning, or who survived, or survived with an impairment.

I was traumatized as a second-year resident covering the PICU one night when a child was admitted after falling into a home spa.

Our attending asked me if I told the family that they needed to fill their spa with concrete to avoid the risk of further incidents Imagine my horror and his when, the following year, the child was admitted after once again falling into the spa. Fortunately, the child recovered, but the terrible feelings I experienced linger to this day.

In the late 1970s, that attending made sure the staff knew that not only treating but preventing child injury was in our wheelhouse — and with good reason. It is a lesson I have never forgotten.

While we have made great strides in reducing child drowning deaths in the last 20 years, there is still much work to be done.

The American Academy of Pediatrics published a technical report, Prevention of Drowning, on July 12, 2021, summarizing all the evidence around drowning prevention. It follows a policy statement by the same name in 2019. In these documents, AAP recommends that we assess each child for drowning risk and tailor our anticipatory guidance. The report also notes that it is important to emphasize that no single intervention is fully protective. Multiple layers are recommended to prevent drownings.

The five critical evidence-based interventions that contribute to a reduction in childhood drowning deaths are: barriers, supervision, swim lessons, life vests, and CPR.

It is time to also consider changing our key messages that can help change norms and behavior over time. For example, the auto industry initially fought against air bags, and now they are standard equipment in vehicles. There is now widespread acceptance of their importance and value in protecting us in a collision.

A critical element in drowning prevention is the installation of an isolation fence with a self-closing and self-latching gate that meets Consumer Product Safety Commission standards.

I believe we can do the same with swimming pools, spas, and hot tubs. A critical element in drowning prevention is the installation of an isolation fence with a self-closing and self-latching gate that meets Consumer Product Safety Commission standards. The pool and spa industry and pool owners can be persuaded to install these life-saving fences and gates if we try creative solutions such as tax rebates, vouchers, and reduced homeowner liability insurance premiums.

We must find the most successful way to implement these guidelines in our own communities. We need to be innovative and try local solutions for local issues. That means assessing our own states and communities with respect to the drowning data, modifiable risk factors, community resources, political climate, and the most effective implementation strategies.

Strong public health interventions such as tobacco and sugary beverage taxes, bans on smoking in public places, and COVID-19 restrictions all began at the local level and then worked their way up to the state level. As pediatricians, we are uniquely positioned to support such measures and amplify them in our communities.

Here in California, State Sen. Josh Newman was able to secure passage of the 2017 Pool and Spa Safety Act. The California chapter of AAP is now working to improve the law based on the latest evidence we have and the need to enhance surveillance.

State laws typically set a floor, allowing us to work toward reaching the ceiling in our own local municipalities. If we can successfully launch local pilot programs to gather evidence-based data that supports AAP recommendations for drowning prevention, we can continue to impact one community after another until the recommendation becomes the new norm across our states. That’s how substantive change works – incrementally.

The new AAP recommendations also call for properly fitting a young child and any unskilled swimmer with a U.S. Coast Guard-approved life jacket. As pediatricians, we can educate parents on why life jackets should become part of their children’s swim routine. To make sure that life jackets are affordable, we can reach out to partners in our local communities requesting they provide affordable and accessible life jackets.

We also can encourage parents and guardians to assign a water watcher whenever children are in or near the water. That person’s only job is to keep a close eye on the children in the group while at the pool or lake or beach. Watchful adults are a solid defense against drowning.

While we tend to think globally and nationally, we must act locally using data from our communities to shape the policies that will contribute to reducing child drownings.