Accidental Drowning in Children: Overview, Prevention, and Treatment
By: Madison Davis MPH Candidate, Brown University School of Public Health
Background
Drowning can be defined as being unable to breathe as a result of being submerged in water. When a person is submerged underwater, they experience a laryngeal spasm reflex which closes off their airway and prevents oxygen from going to the brain1. Accidental drowning is one of the leading causes of death among children in the United States2. Specifically, drowning is the second leading cause of death among children between the ages of 1 and 142. As we approach warmer months, it is important to understand how to prevent and treat as numbers will be on the rise. On average, there are about 3,960 fatal and 8,080 nonfatal, accidental drownings per year2,3. Even in the case on nonfatal accidental drownings, more than 40% of children treated in the emergency department subsequently require hospitalization or relocation for more intense care2.
At Risk Population
Children between the ages of 1 and 4 are most at risk2. Drownings among children tend to occur in swimming pools3. Males are also more at risk than females for fatal, accidental drownings2. This is often due to increased exposure to water, increased risk-taking behaviors, and alcohol use4,5. Black children between 10 and 14 are 7.6 times more likely to die from accidental drowning than white children6.
Secondary Drowning
Secondary drowning is when a water enters the lungs/airway of a child prior to the laryngeal spasm reflex1. If excessive amounts of water enter the airway, lung damage can occur and become more serious 6-12 hours after the incident1. The signs and symptoms of secondary drowning include1:
Change of skin color
Heavy coughing
High fever
Loss of consciousness
Shortness of breath
Vomiting
Treatment
The most important factor in treating someone who has experienced a drowning is ventilation7. Oxygenation, ventilation, and perfusion should be the top priority; thus, CPR should be administered as soon as possible7. A secondary factor in treating those who have experienced a drowning is the possible presence of primary or secondary hypothermia8. However, c-spine stabilization is not indicated unless there was trauma involved in the drowning incident7. Common trauma incidents include diving, water slides, signs of injury, or alcohol intoxication7. There is also not a need to remove small amount of aspirated water from the victim’s mouth or perform the abdominal thrusts or the Heimlich maneuver7.
Pulling the victim from the water quickly is important7. Prompt ventilation via mouth-to-mouth or BVM is recommended: 2 rescue breathes should be administered once removed from water7. If the victim does not have a pulse, then chest compressions should subsequently begin7. Cycles of CPR should continue until a pulse is returned7. If an AED is present, that should be properly used on the patient if indicated7. If the patient vomits during CPR, then they should be rolled on their side and the vomit should be suctioned out or removed by the rescuer7.
Some modifications to ACLS include the use of surfactant for fresh water-induced drownings and extracorporeal membrane oxygenation for cases of severe hypothermia9-13. However, the use of barbiturates, steroid, nitric oxide, therapeutic hypothermia, or vasopressin are not supported14-17.
Prevention
Many fatal, accidental drownings occur due to children who are unable to swim having access to water5. This could be due to ineffective fencing around pools, a lack of supervision and life jackets, or the consumption of drugs and alcohol5. However, the common location of drownings for each age varies. The highest risk of drowning for infants under 1 year is reported to occur in bathtubs; however, for children 1-4 years of age, drownings tend to occur in residential swimming pools3. Furthermore, for adolescents 15 years or older, the majority of drownings both fatal and nonfatal occur in natural bodies of water such as lakes, rivers, or oceans3.
There are a few important precautions that can be taken to avoid a drowning incident. While in a natural body of water, look for steep drops, hazardous currents, or opaque water18. For at home pools, it is vital to have a safe perimeter to prevent accidents or unsupervised swimming18. In any body of water, if not a strong swimmer, swimming with friends, wearing a life jacket, having a dedicated watcher/constant supervision, and understanding basic first aid is important18. Furthermore, checking side effects of medications to ensure they do not make you drowsy or impaired and consulting a provider on medication use while swimming18.
Wide-ranging Online Data for Epidemiologic Research (WONDER). 2021; https://wonder.cdc.gov/.
Lawes J, Ellis A, Daw S, Strasiotto L. Risky business: a 15-year analysis of fatal coastal drowning of young male adults in Australia. Injury prevention. 2020.
Denny S, Quan L, Gilchrist J, et al. Policy Statement – Prevention of Drowning American Academy of Pediatrics (AAP) – Council on Injury, Violence, and Poison Prevention. 2019;143(5).
Clemens T, Moreland B, Lee R. Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years – United States, 1999-2019. MMWR. 2021.
Part 10.3: Drowning. American Heart Association. 2005;112:133-135.
Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics. 1992;90(6):909-913.
Bolte RG, Black PG, Bowers RS, Thorne JK, Corneli HM. The use of extracorporeal rewarming in a child submerged for 66 minutes. Jama. 1988;260(3):377-379.
Onarheim H, Vik V. Porcine surfactant (Curosurf) for acute respiratory failure after near‐drowning in 12 year old. Acta anaesthesiologica scandinavica. 2004;48(6):778-781.
Staudinger T, Bankier A, Strohmaier W, et al. Exogenous surfactant therapy in a patient with adult respiratory distress syndrome after near drowning. Resuscitation. 1997;35(2):179-182.
Suzuki H, Ohta T, Iwata K, Yamaguchi K, Sato T. Surfactant therapy for respiratory failure due to near-drowning. European journal of pediatrics. 1996;155(5):383-384.
Thalmann M, Trampitsch E, Haberfellner N, Eisendle E, Kraschl R, Kobinia G. Resuscitaton in near drowning with extracorporeal membrane oxygenation. The Annals of thoracic surgery. 2001;72(2):607-608.
Foex BA, Boyd R. Corticosteroids in the management of near-drowning. Emergency Medicine Journal. 2001;18(6):465-466.
Takano Y, Hirosako S, Yamaguchi T, et al. Nitric oxide inhalation as an effective therapy for acute respiratory distress syndrome due to near-drowning: a case report. Nihon Kokyuki Gakkai Zasshi= the Journal of the Japanese Respiratory Society. 1999;37(12):997-1002.
Williamson JP, Braude S, Illing R, Gertler P. Near-drowning treated with therapeutic hypothermia. The Medical Journal of Australia. 2004;181(9):500-501.
Sumann G, Krismer A, Wenzel V, et al. Cardiopulmonary resuscitation after near drowning and hypothermia: restoration of spontaneous circulation after vasopressin. Acta anaesthesiologica scandinavica. 2003;47(3):363-365.
Accidental Drowning in Children: Overview, Prevention, and Treatment
By: Madison Davis MPH Candidate, Brown University School of Public Health
Background
Drowning can be defined as being unable to breathe as a result of being submerged in water. When a person is submerged underwater, they experience a laryngeal spasm reflex which closes off their airway and prevents oxygen from going to the brain1. Accidental drowning is one of the leading causes of death among children in the United States2. Specifically, drowning is the second leading cause of death among children between the ages of 1 and 142. As we approach warmer months, it is important to understand how to prevent and treat as numbers will be on the rise. On average, there are about 3,960 fatal and 8,080 nonfatal, accidental drownings per year2,3. Even in the case on nonfatal accidental drownings, more than 40% of children treated in the emergency department subsequently require hospitalization or relocation for more intense care2.
At Risk Population
Children between the ages of 1 and 4 are most at risk2. Drownings among children tend to occur in swimming pools3. Males are also more at risk than females for fatal, accidental drownings2. This is often due to increased exposure to water, increased risk-taking behaviors, and alcohol use4,5. Black children between 10 and 14 are 7.6 times more likely to die from accidental drowning than white children6.
Secondary Drowning
Secondary drowning is when a water enters the lungs/airway of a child prior to the laryngeal spasm reflex1. If excessive amounts of water enter the airway, lung damage can occur and become more serious 6-12 hours after the incident1. The signs and symptoms of secondary drowning include1:
Treatment
The most important factor in treating someone who has experienced a drowning is ventilation7. Oxygenation, ventilation, and perfusion should be the top priority; thus, CPR should be administered as soon as possible7. A secondary factor in treating those who have experienced a drowning is the possible presence of primary or secondary hypothermia8. However, c-spine stabilization is not indicated unless there was trauma involved in the drowning incident7. Common trauma incidents include diving, water slides, signs of injury, or alcohol intoxication7. There is also not a need to remove small amount of aspirated water from the victim’s mouth or perform the abdominal thrusts or the Heimlich maneuver7.
Pulling the victim from the water quickly is important7. Prompt ventilation via mouth-to-mouth or BVM is recommended: 2 rescue breathes should be administered once removed from water7. If the victim does not have a pulse, then chest compressions should subsequently begin7. Cycles of CPR should continue until a pulse is returned7. If an AED is present, that should be properly used on the patient if indicated7. If the patient vomits during CPR, then they should be rolled on their side and the vomit should be suctioned out or removed by the rescuer7.
Some modifications to ACLS include the use of surfactant for fresh water-induced drownings and extracorporeal membrane oxygenation for cases of severe hypothermia9-13. However, the use of barbiturates, steroid, nitric oxide, therapeutic hypothermia, or vasopressin are not supported14-17.
Prevention
Many fatal, accidental drownings occur due to children who are unable to swim having access to water5. This could be due to ineffective fencing around pools, a lack of supervision and life jackets, or the consumption of drugs and alcohol5. However, the common location of drownings for each age varies. The highest risk of drowning for infants under 1 year is reported to occur in bathtubs; however, for children 1-4 years of age, drownings tend to occur in residential swimming pools3. Furthermore, for adolescents 15 years or older, the majority of drownings both fatal and nonfatal occur in natural bodies of water such as lakes, rivers, or oceans3.
There are a few important precautions that can be taken to avoid a drowning incident. While in a natural body of water, look for steep drops, hazardous currents, or opaque water18. For at home pools, it is vital to have a safe perimeter to prevent accidents or unsupervised swimming18. In any body of water, if not a strong swimmer, swimming with friends, wearing a life jacket, having a dedicated watcher/constant supervision, and understanding basic first aid is important18. Furthermore, checking side effects of medications to ensure they do not make you drowsy or impaired and consulting a provider on medication use while swimming18.
References
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