HJBR May/Jun 2019

Healthcare Journal of BATON ROUGE  I  MAY / JUN 2019 53 Mindy Calandro, MD Pediatrician five minutes. For every child that dies from drowning, another four are treated in emergency rooms for near drowning. If numbers like these don’t absolutely petri- fy you as a parent or healthcare provider, I am not sure what will. We know that drowning, especially in the toddler years, occurs almost 70 percent of the time during non-swim times when children were not expected to be in or near water. Everyone knows that toddlers are adventurous people who love to explore and learn about their environment, and pools or other bodies of water are quite enticing to those little minds. The water is often sparkly with the reflection of the sun, it makes fun ripples, and things like toys and ducks can float on the top of the water. This is a powerful pull to curious toddlers and preschoolers.   To be clear, when a child is drowning, it will look absolutely nothing like drown- ing does in the movies. They do not splash around or make much noise, especially the younger they are, as their body is just not physically able to get to the top of the water to flail around, let alone scream or utter enough noise to get anyone’s atten- tion. In my son’s case, he was three and a half, and this was exactly what happened— silence. Submersion takes less than 10 sec- onds to occur, a child can lose conscious- ness in two minutes, and suffer permanent brain injury in four to six minutes. While drowning incidents in swimming pools and lakes probably gets the most attention, children, especially infants, can drown in as little as one inch of water, which means the bathtub, a bucket of standing water, or a kiddie pool. Layers of Protection The best way to prevent drownings and keep children safe from all sorts of water-related injuries is through ACTIVE adult supervision. An adult who knows how to swim should be within arms reach, or touch supervision, of a child anytime they are in the water. If there are multiple adults around while children are swim- ming (for example, at a backyard pool par- ty), have a designated water watcher. This adult’s sole job is to be in charge of ALL of those swimming, paying attention to the entire pool as a lifeguard would do, and not distracted by television, cell phones, involved in other conversations away from the pool, or drinking alcohol. Most well-meaning parents will focus on only their own children, and even then, not ex- clusively watching them in the water. They are also enjoying the party and the com- pany of other adults, which leads to over- looking a child in trouble in the water, or even their own child in a moment of dis- traction. If you are ever having a pool party with lots of young kids, designate a water watcher. If there will be a lack of parents, hire a professional. Here are other layers of protection to put into place to keep children safe around water: • Swimming pools should be surrounded by a four-sided fence that is at least four feet high. The fence should have a gate that opens outward and is self-latching and self-closing. The latch for the gate should always be at least 54 inches from the ground. • Pool alarms that alert when there are either waves on the surface or underwa- ter movement can break the silence of drowning. • Ensure that doors in the home leading to the pool area also have alarms so that someone would be alerted if a door is opened. • Remove all pool toys from the pool area after swimming. What could be more tempting for a young child than a brightly colored beach ball or pool noodle floating in the water? • Suction from drains poses an entrap- ment risk, so make sure all drains have appropriate covers. Avoid loose clothing and tie back long hair to prevent children getting sucked into drains. Swimming Lessons Finally, what about swimming lessons? Previously the American Academy of Pe- diatrics did not recommend formal swim- ming lessons until four years of age. How- ever, this year in a policy statement update, the AAP now acknowledges that swim- ming lessons beginning at one year of age can help reduce drowning risk between one and four years of age. The decision to enroll a child under four in swimming les- sons should be made based on their devel- opmental readiness, as well as their expo- sure to water (i.e. if you have a pool, pond, lake, or other waterway in your backyard or near your home, the sooner the better). There is no evidence at this time that swim instruction or survival skills can prevent drowning in infants under one year of age. In the end, no matter a child’s age or the number of swimming lessons they have had, no child is drown-proof, and parents should not view formal swim training as a guarantee that a child will not drown.   As healthcare providers, much of this information may not come as a surprise to you, but I hope my story serves as a re- minder that downing can happen to any- one. No matter your level of training, no matter how much you think you under- stand drowning (In fact, I did an advoca- cy project on drowning prevention during my residency.), it can happen in an instant. As summer is fast approaching, take the opportunity to talk with your patients, children, parents, grandparents, friends, and anyone who may need to hear about drowning prevention. Your reminder about pool safety might just save a life. n