Pediatric resident Amina Khan says it was the confluence of summer approaching and her 16-month-old daughter’s recent introduction to a swimming pool that triggered her interest in the incidence of drowning among children and the current guidelines for water safety for children. Here she shares some of what she learned and presented at a recent Grand Rounds at Hopkins Children’s.
Any surprises in reviewing the literature on drownings and water safety?
Yes, I was surprised to learn that drowning is the second leading cause of injury and related death among children 1 to 14 years-old, and that those under age 4 have the highest drowning rate. I was also surprised that 50 percent of infant drownings occur in bathtubs, and that 96 percent of the time the infant was left unsupervised. For children 1 to 4 years of age, drownings occur mostly in residential swimming pools, and among 5 to 14-year-olds, in lakes and rivers.
How do you explain the high incidence of bathtub drownings and parents leaving their infants unsupervised?
Part of the problem may be the common practice of using bathing aides like bathtub seats and rings that make bathing a lot easier. They may give parents a false sense of security that they can leave their child or infant unsupervised. In studies parents say they left their infant in the tub for less than 30 seconds, and usually for something like a towel or a diaper. It’s understandable but not advisable. The important thing is to make sure you have everything before you give your baby a bath.
Do some parents leave their infant unsupervised because an older sibling is in the tub, too?
Studies show that some parents are willing to leave their infant in the tub with an older sibling, even though these older siblings tend to be 18 months to 2 ½ year-olds who are not capable of verbalizing or taking care of a younger child. Maybe the parent feels “Oh, the older child can keep an eye on him for a few minutes.” But an infant can drown in as little as 5 centimeters of water, and it only takes two minutes under water to cause brain damage.
So what are the water-safety recommendations for the home?
Never leave an infant unattended in a tub, avoid bathing infants with older siblings, install locks on toilet bowls, and keep large buckets empty and turned over.
How about water safety in pools and open water? Are swimming lessons helpful for infants and toddlers?
The studies are inconclusive. Some studies have shown that children under age 4 can learn aquatic readiness – to float and tread water – and by age 4 have the flexibility and the motor skills to actually do strokes and recognize when they would need those skills. The American Academy of Pediatrics (AAP), on the other hand, does not recommend swimming lessons for children under 4, stressing they are not developmentally ready to swim. Yes they can learn to float and tread water, but they may not recognize the situations in which they need to use those skills. These children may also become overconfident and put themselves in risky situations involving water, and parents may tend to feel it’s safe to leave their child alone in the water because he or she had swimming lessons.
Where does that leave parents of younger children?
There is nothing wrong with introducing children to water. They can overcome the fear of water and learn the basic skill of floating and treading water. But parents need to recognize that having those skills does not prevent a child from drowning. And that’s where pediatricians can step in and spread the message about water safety and keeping a close eye on your children.
Are they spreading the message?
In one of the studies I looked at 33 to 44 percent of parents said they received no advice from their pediatrician on bathing safety and infants. And in going through this review I realized I don’t give much water-safety information to parents as well. So I don’t think there is very much guidance from pediatricians.
Why is that?
Part of it may be practicing in an urban setting where there’s not much water and drownings are not as much of an issue as motor vehicle accidents. But in the summer a lot of my patients plan on swimming, but they don’t know how to swim and they can’t afford swimming lessons. That’s a problem that needs to be addressed, especially in urban settings. Parents and pediatricians are not aware of what resources are available to help children learn how to swim. It is a life-saving skill and it does help.
For more information, see the American Academy of Pediatrics policy statement on the Prevention of Drowning in Infants, Children, and Adolescents