The Importance of Water Safety: Prevention is Key

6/1/2021 | Meika Eby, MD

In the US, drowning is the #1 cause of injury related death in ages 1-4 years and the #3 cause of unintentional injury-related death in ages 5-19 years. Although most drownings happen in residential swimming pools, children can drown in just one inch of water such as in buckets, bathtubs, wading pools, toilets, hot tubs, and spas. In addition, natural waters such as oceans, rivers, streams, lakes and ponds pose a drowning threat to older children. Most children who survive being submerged in water without brain damage are discovered within 2 minutes. Most who die are found after 10 minutes.

Parents are advised to take the following preventive steps to protect their children from drowning:


  • Never leave your child unsupervised near water at or in the home, or around any body of water, including baths, pools, spas, natural water sources, and open standing water.
  • When supervising noncompetent swimmers (including infants and toddlers), an adult with swim skills should be within an arm’s length.
  • With competent swimmers, designate a “water watcher” who will avoid distracting activities such as socializing, cell phone use, or drinking alcohol. Be sure to give clear hand-off of responsibility when taking turns.

Preventative skills

  • Parents, caregivers, and pool owners should learn cardiopulmonary resuscitation (CPR) and infant and child first aid.
  • Learn water safety skills and teach children never to swim alone and never to swim without adult supervision.
  • Consider swimming lessons for children over 1 year old.

Protective equipment

  • Install childproof fencing around swimming pools. Four sided, 4-foot tall fencing is recommended, with a self-closing and self-latching gate.
  • Make sure you have rescue equipment, a phone, and emergency phone numbers nearby.
  • Children and adolescents should wear a U.S. Coast Guard-approved personal flotation device (PFD) when in or on watercraft, at all times.

Remember, even with preventative skills and protective equipment/devices, your child is still at risk without proper supervision.

For more information on drowning prevention, visit the US Consumer Product Safety Commission site by clicking here.

Drowning Q&A:

Who is at the highest risk of drowning?

Infants and children between ages 0-4 years, with ages 12-36 months being at highest risk. Also, teenagers 15-19 years old, especially if alcohol or substance use is involved. Those with medical conditions such as seizure disorders, autism spectrum disorder, and cardiac arrythmias also have a higher risk.

Is it true that you can drown in 1 inch of water?

Yes, especially in younger infants and children. Most people remember to take precautions around pools and larger bodies of water, but do not necessarily think about shallower hazards such as toilet bowls, inflatable or plastic children’s pools, fluid filled buckets, bird baths, and creeks/ditches.

I’ve been seeing articles on social media - what is dry drowning?

The words ‘dry drowning’ or ‘secondary drowning’ have been used to refer to victims who have been submerged in water but do not develop symptoms, and then unexpectedly die days to weeks later.

The actual definition of drowning used by medical professionals is “the process of experiencing respiratory impairment from submersion/immersion in liquid.”

Although commonly on social media and many news outlets, ‘dry downing’ is not a medical condition, nor are the following:

  • Wet or dry drowning
  • Secondary or passive drowning
  • Active drowning
  • Near drowning
  • Silent drowning

Most of the cases presented in the news as ‘dry drowning’ were found to have other causes of death which could not be attributed to the drowning incident.

The key take away from all of this is that drowning victims have respiratory impairment or symptoms. These symptoms may be mild to minimal initially but are present within hours. Those who do worsen, usually do so within 4-8 hours of the submersion event. Drowning victims will not be completely asymptomatic for days or weeks and then suddenly die; if they do, it is from other causes and not from direct respiratory damage from the initial drowning event.

What do I do if my child swallowed water? What if it was pond water?

Swallowed water is not the same as inhaled water. Swallowed water goes into the esophagus and stomach, whereas inhaled water goes into the airway and lungs. Your child may be scared or upset immediately after the incident, and may cough, gag or even throw up. However, after your child has calmed, if they are otherwise fine without further symptoms, it is okay to watch them at home. Do seek care if they develop persistent vomiting or persistent choking/gagging/cough, breathing problems such as difficulty breathing or fast or labored breathing, confusion or altered mental status, or fevers.

Small amounts of swallowed pond or lake water do not require any medical intervention as they do not often cause major issues. Your child may have some mild stomach upset. Do seek care for persistent vomiting or any blood in the vomit or stools.

My child was swimming all day and did not go under water but seems tired, should I bring her to the doctor?

No, it is common for children to be tired after a day of swimming. Do seek care if your child is truly lethargic meaning limp or difficult/unable to be aroused.

My child went underwater briefly and seemed like they were choking and gagging immediately after but seems to be fine now, what symptoms should I look for?

Seek care if they develop any of the following:

  • Persistent vomiting
  • Persistent choking, gagging, or excessive cough
  • Breathing problems such as difficulty breathing, fast, or labored breathing
  • Confusion or altered mental status or abnormal behavior
  • Excessive sleepiness or lethargy
  • Fevers or low body temperatures

What do I do if I witness a drowning?

Call 911 first. If you are a competent swimmer, quick rescue* from the water and immediate, effective CPR are important. Prompt CPR before emergency medical services (EMS) arrival is very important for patient outcome.

*Quick rescue may not be feasible for bystanders in dangerous situations (such as ice water, rapid flowing dams/flood water, etc). It is extremely important for your own safety to wait for trained rescuers.

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