I’m a pediatric emergency physician. This is what every parent should know about swimming pool safety.
It is mid-morning on a busy summer Saturday when I hear the BEEP BEEP BEEP of the EMS radio.
“This is unit 18. We are 5–7 minutes out from your facility. Onboard, I have a four-year-old boy who was found face down in a swimming pool. It is unknown how long he was down. When we got there, CPR was ongoing. He came back and was breathing spontaneously just after we arrived. He is currently breathing 50 times per minute with a pulse ox of 85% on a non-rebreather. Heart rate is 120s.”
This child is breathing way too fast and his blood oxygen level (pulse ox) is low. I am waiting with the team as this child arrives. He is in severe respiratory distress and I know if we don’t place a breathing tube quickly, his lungs will not continue to supply his body with needed oxygen much longer. EMS has already placed an IV. Sedative medications are hurriedly administered, and the tube is placed. We do a chest x-ray that shows fluffy patches in both lungs, a consequence of the water he inhaled. I notice that extraordinarily high pressures on the ventilator are needed to keep his blood oxygen level up — this boy’s lungs are sick. Only ten minutes after arrival, I escort him to the pediatric ICU.
When I arrive back to the department, I speak to EMS and the child’s mother to learn more details. Both mom and patient were gathered at a community pool, one that employs lifeguards. Mom was in the water near the child chatting with friends. Only six feet away her son was face down in the water and unresponsive. There were at least fifteen adults in or near the pool at the time. It is a tight-knit neighborhood and every single person there knew the boy’s name.
None of them were aware that he was drowning at their feet.
I encountered the patient’s mom about a year later when she brought one of her other children to the emergency department with a minor laceration. She was tearful when she told me, “He was in the hospital for a week, but walked out and is doing fine”.
There are hundreds of pediatric drowning deaths annually in the US.[i] In 2017, this number rose to nearly 1000 children who died in drowning accidents.[ii] In fact, drowning is the number one cause of unintentional death among children aged 1 to 4 years and the third leading cause of death in children over age 5.[iii] Thousands more survive but require emergency care. Thousands of others are near-misses that are never reported. Accidents definitely happen around water. Every accidental pediatric drowning that I have seen, whether in a bathtub, swimming pool, lake, river, or ocean have all shared a common thread — there was no adult who was actively watching.
Because it takes only a few seconds for a child to drown, it is paramount that an adult is responsible for watching children near the water. This cannot be a shared responsibility, but one that must be passed off from adult to adult such that there is never a moment’s lapse. Re-read the vignette at the start of this chapter. There were fifteen adults plus a lifeguard at this pool. Not one of them was dedicated and solely responsible for this child’s safety. Had one of them been committed to this purpose, he likely would have been quickly snatched from the water, coughed a few times, and gone back to enjoying a carefree day with family and friends.
Swimming pool safety. There are multiple ways to protect kids in and around swimming pools, some with good scientific evidence to support them, and others not as much. For example, pool alarms, devices that sound an alarm when someone goes into the pool, have never been demonstrated to prevent drowning[v]. There are a few interventions that have been substantiated in scientific studies to prevent drowning:107
1. NEVER leave a young child alone near a swimming pool, even for a second.
2. Small children or weak swimmers should have an adult caregiver in the pool, within arm’s reach, supervising the child.
3. Older children should have an undistracted adult caregiver solely focused on the child while he is in the pool.
4. Supervising adults should be strong swimmers.
5. Supervising adults should be CPR certified.
6. If your child is cared for outside of the home (in daycare, for example), it is paramount to ensure that those environments meet these supervision standards.
7. If you have a pool at home, you must have a fence that encloses the pool and is at least four feet high. It should have a self-latching gate and separate the pool from the house. These measures can prevent half of all drownings.[vi]
8. Swim lessons are helpful for children over the age of one, but not a substitute for supervision. Most children under four can begin to learn pool rules and how to swim from qualified professionals. However, this depends on the child and how ‘ready’ they are to learn.
A good resource for more information is poolsafely.gov.
Diving. More than 6500 children are injured in diving accidents each year.[vii] More than 90% of these injuries occur in swimming pools. In one recent series, 20% of children with cervical spine injuries were hurt while diving.[viii] Diving can be dangerous. However, the dangers can easily be mitigated:
1. Never allow diving in an above ground pool
2. Never allow diving where there is a sign that says, “No Diving”
3. Always test the depth of water that your child is going to dive into
4. Particularly in natural bodies of water, make sure there are no obstacles/objects on the bottom that can create a hazard
5. Do not allow children to dive through pool toys and floats
[i] Home and Recreational Safety. (2016, April 28). Retrieved January 30, 2019, from https://www.cdc.gov/homeandrecreationalsafety/water-safety/waterinjuries-factsheet.html
[ii] Sarah A. Denny, Linda Quan, Julie Gilchrist, Tracy McCallin, Rohit Shenoi, Shabana Yusuf, Benjamin Hoffman, Jeffrey Weiss, the Council on Injury, Violence, and Poison Prevention. Pediatrics Mar 2019, e20190850; DOI: 10.1542/peds.2019–0850
[iv] Rauchschwalbe R, Brenner RA, Smith GS. The role of bathtub seats and rings in infant drowning deaths. Pediatrics. 1997;100(4)
[v] Weiss, J. (2010). Prevention of Drowning — Technical Report. Pediatrics, 126(1), E1-E10. Retrieved January 31, 2019.
[vi] Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database Syst Rev. 2000;(2).
[vii] Day, C., Stolz, U., Mehan, T. J., Smith, G. A., & Mckenzie, L. B. (2008). Diving-Related Injuries in Children. Pediatrics, 122(2). doi:10.1542/peds.2008–0024
[viii] Babcock, L., Olsen, C. S., Jaffe, D. M., & Leonard, J. C. (2016). Cervical Spine Injuries in Children Associated With Sports and Recreational Activities. Pediatric Emergency Care, 34(10), 677–686. doi:10.1097/pec.0000000000000819