In 2010, the American Academy of Pediatrics (AAP) issued updated water safety and drowning prevention advice for parents, dropping opposition to swimming lessons for infants and toddlers and highlighting new drowning risks - including large, inexpensive, portable and inflatable pools and pool and spa drain body entrapment and hair entanglement injuries - that have recently emerged.
"To protect their children, parents need to think about layers of protection," said Jeffrey Weiss, MD, FAAP, lead author of the policy statement and technical report, published in the July 2010 print issue of Pediatrics.
While drowning rates have fallen steadily from 2.68 per 100,000 in 1985 to 1.32 per 100,000 in 2006, drowning continues to be the second leading cause of death for children ages 1 to 19, claiming the lives of roughly 1,100 children in 2006. Toddlers and teenaged boys are at greatest risk.
The AAP believes parents can reduce the risk of drowning further by taking the following steps:
- Never leave your child alone. Never - even for a moment - leave small children alone or in the care of another young child while in bathtubs, pools, spas or wading pools, or near irrigation ditches or standing water. Bath seats cannot substitute for adult supervision. Empty water from buckets and other containers immediately after use. To prevent drowning in toilets, young children should not be left alone in the bathroom.
- Provide close, constant, and capable supervision. An adult with swimming skills should be within an arm's length whenever infants, toddlers or weak swimmers are in the water, be it a pool or an open body of water ("touch supervision"). With older children and better swimmers, an adult should be focused on the child and not distracted by other activities. This means no talking on the phone, socializing, tending to chores, or drinking alcohol.
- Be prepared for emergencies. In addition to knowing how to swim, the supervising adult must know how to perform a rescue, initiate CPR, and call for help. Parents, caregivers, older children and adolescents, and pool owners should learn CPR. Life buoys, life jackets, an a reach tool such as a shepherd's crook should be kept at poolside.
- Ask day-care providers about water safety & check applicable laws. If children are in out-of-home child care, ask about exposure to water and the ratio of adults to children. Child-to-staff ratios while children are wading or swimming vary according the age of the child and by jurisdiction. Some states include staffing ratios in their child care and school licensing requirements.
- Install a four-foot high isolation fence. If you have a pool, install a four-sided, climb-resistant (e.g. not chain link) fence that is at least 4 feet high (or higher if required by local ordinance) and has a self-latching, self-closing gate that opens away from the pool to limit access to the pool. Families may consider pool alarms and rigid pool covers as additional layers of protection, but neither can take the place of a fence. "A fence that completely surrounds the pool - isolating it from the house - can cut drowning risk in half," says Dr. Weiss. "Unfortunately, laws regarding pool fencing may have dangerous loopholes."
- Be especially cautious with above-ground or inflatable pools. Large, inflatable above-ground pools can contain thousands of gallons of water and may even require filtration equipment, so they are left filled for weeks at a time. But because they are considered "portable," these pools often are exempt from local building codes requiring pool fencing. From 2004 to 2006, the Consumer Product Safety Commission (CPSC) reported 47 deaths of children related to inflatable pools. "Because some of these pools have soft sides, it is very easy for a child to lean over and fall headfirst into the water," Dr. Weiss said. "These pools pose a constant danger."
- Install drain-covers and filter-pump equipment to prevent body entrapment/hair entanglement injuries. Body entrapment and hair entanglement in pool and spa drains are real, but preventable dangers.
- Teach your kids to swim. The AAP continues to support swimming lessons for most children 4 years and older, but has dropped its its recommendation against lessons for younger toddlers and children, which was based on concern that they were not developmentally ready for swimming lessons, a lack of data showing infant and toddler aquatic programs decreased the likelihood of drowning, and would cause parents to develop a false sense of security and lead them to provide inadequate supervision around water (see point #1 above). The AAP's new position that the decision about starting swimming lessons or water-survival skills training at an early age should be up to parent's based the child's frequency of exposure to water, emotional maturity, physical limitations, and health concerns related to pool water infections and pool chemicals. The AAP does not recommend formal water safety programs for children younger than 1 year of age. The water-survival skills programs for infants may make compelling videos for the Internet, but no scientific study has yet demonstrated these classes are effective, the policy states. "Children need to learn to swim," Dr. Weiss said. "But even advanced swimming skills cannot ‘drown-proof' a child of any age."
- Use water wings with caution. Air-filled swimming aids (such as inflatable arm bands) should not be used in place of Coast Guard-certified personal flotation devices (PFDs) or life vests/jackets. They can deflate and are not designed to keep swimmers safe.
- Require your children to wear life jackets when boating. All children should wear a portable floatation device (PFDs/life jackets) when riding in a boat. Small children and nonswimmers should also wear one at water's edge, such as on a river bank or pier.
- Check water depth before allowing diving. Recreational diving is more dangerous than you might think. Parents should know the depth of the water and any underwater hazards before allowing children to jump in. The first time your child enters the water, he should jump feet first, not dive.
- Look for lifeguards/select a safe swimming location. When choosing an open body of water for children to swim in, select a site with lifeguards. In swimming in the ocean, make sure your child knows what to do in case of rip currents (swim parallel to the shore until out of the current, then swim back to the shore).
- Don't let your child go near weak or thawing ice. Children should not walk, skate, or ride on weak or thawing ice on any body of water.
- Teach alcohol awareness to teens, especially boys. Counsel teenagers about the increased risk of drowning when alcohol or illegal drugs are involved. Because male adolescents are at much higher risk of water-based injuries than girls, they warrant extra counseling.
Source: American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. "Policy Statement - Prevention of Drowning." Pediatrics (published online May 24, 2010)
Created June 8, 2010; updated June 1, 2012