There’s a Disturbing Truth About Pediatric Drownings (2024)

Shannon Olsen had only been at the water park’s toddler event for a few minutes when she decided to leave. A nurse, she had a rule when her kids were little that if they could see water, they were in their life jackets. But on a summer day five years ago, she had taken them off her daughter, then age 4, and son, age 2, at the insistence of a lifeguard. Very quickly, she felt uncomfortable about the situation.

She turned to tell her daughter that they’d have to cut their day short. That’s all the time it took for her son to disappear. Ten minutes later, another patron found the boy in a nearby pool. He was blue, with no pulse. Olsen was running back from searching the other side of the park when she saw the look on people’s faces.

“Kind of a weird statement, but I just said, ‘You found him, right? Is he still alive?’ ” she recalls. “And they were like, ‘No. They’re doing CPR on him right now.’ ”

Drowning is the No. 1 cause of death for kids ages 1 to 4 in the U.S., beating out congenital abnormalities and car accidents. And it’s the third cause of unintentional injury-related death for kids 5 to 19. The prevention of drowning—which is defined as submersion in liquid that impairs breathing and, contrary to common knowledge, isn’t always fatal—is, in some ways, straightforward. For instance, adults should supervise children who are swimming. In May, a paramedic asked Slate’s parenting advice column how to handle a situation where her neighbor’s 5-year-old daughter was being left alone in the pool. The neighbor is clearly in the wrong here: Leaving a child, especially such a young one, unattended in a pool is extremely dangerous. It also constitutes child neglect and is grounds for child protective services to investigate, which could lead to the involvement of a court, says Peter Tilem, attorney and partner at Tilem & Associates in New York. If the daughter drowned and died, he adds, her parent could be charged with a felony.

But the situations that lead to fatal drownings are not usually ones of such blatant negligence. In fact, more often than not, children drown in the presence of their guardians, not their absence. A study back in 2004 that analyzed the drowning deaths of 496 children under 14 years old showed that, alarmingly, only 10 percent of the victims were completely unsupervised when they drowned—in other words, 90 percent of the children who died had an adult nearby who did not see the drowning occur. Drowning happens right under the noses of parents who, often, are aware that their child needs to be monitored in the pool, and who are trying their best to do so.

That’s because it doesn’t take much of a distraction to render supervision ineffective. “It’s the knock on the door,” says Amy Peden, a drowning prevention researcher at the University of New South Wales in Australia. “It’s the call on the phone.”

The day that Olsen’s son lost his pulse in a pool, there were lifeguards, mobs of people, a responsible parent—for all intents and purposes, “supervision” was happening.

Everyone was incredibly lucky that day: The lifeguards and paramedics were able to revive Olsen’s son, and he survived the incident without injury and is now a healthy, rambunctious 7-year-old. Many drowning patients that need resuscitation do not survive, says Jeff Louie, a pediatric emergency physician at MHealth Fairview Masonic Children’s Hospital in Minnesota, where Olsen also works as the trauma program manager. (Nonfatal drownings–which happen roughly twice as often as fatal drownings–can result in serious brain damage and permanent injury.)

Drowning can happen quickly, quietly, and without warning. On TV, drowning looks like screaming and splashing, but that’s a misconception, says Sarah Denny, a pediatrician with a focus in injury prevention at Nationwide Children’s Hospital in Ohio. In real life, it’s almost the opposite. Drowning can look like a head bobbing up and down as a struggling person tries to keep their mouth and nose at the surface, while kids who can’t swim can sink to the bottom in an instant.

“Children playing in the water make noise,” wrote Mario Vittone, a retired coast guard rescue swimmer, in a 2013 article for Slate that details exactly what to watch for. “When they get quiet, you get to them and find out why.”

The most critical component of drowning is the lack of oxygen, which, of course, you can’t access underwater, says Bradley Segura, a pediatric surgeon at Masonic Children’s Hospital. As a child loses the oxygen in their bloodstream, they will eventually pass out; the brain can no longer direct the body to the surface for air. That can take a couple minutes or less. The heart usually continues to beat for a minute or so after that. Once the heart stops, the child’s likelihood of survival plummets, says Louie.

Some drowning victims—though not all—also breathe water into their lungs during panicky breathing. That can trigger laryngospasm, where the vocal cords tighten to block foreign substances from entering the lungs, making breathing even harder. And water that reaches the lungs can cause chemical reactions that introduce further issues. Basically, “a whole cascade of events kicks in pretty quickly that make it pretty devastating,” says Segura.

Ultimately, the most important factor for whether a person will survive drowning—and whether they end up with serious injury—is how long they’re underwater. And that’s another reason why good supervision is so important: every second counts.

The definition of supervision is “really specific,” says Denny. The supervisor needs to be constantly attentive, close by (within arm’s reach for a novice swimmer, she says), capable of identifying drowning, and prepared to intervene.

To study supervision lapses involved in fatal drownings, Peden, the researcher at the University of New South Wales, combed through 15 years of Australian police and coroner reports. She found that nearly a tenth of supervision lapses that resulted in a drowning were due to miscommunication, where one adult thought another adult was watching. That’s one reason why pool parties are so dangerous, and why it’s important to clearly designate which adults will be appropriately supervising. “That blew my mind, that a kid could drown in the company of that many competent adults,” says Peden.

Common causes of distraction for pool chaperones, Peden found, were household chores and socializing with other adults. Other causes included having to watch multiple kids at once (like in Olsen’s case); using phones or computers; and, in a few tragic instances, experiencing a sudden medical event that prevented the adult from supervising. Peden also found that roughly 40 percent of drownings happened in the presence of another child,perhaps because the presence of a sibling or friend provides a false sense of security. But “if we think adults aren’t going to see when a drowning is happening, how is the child going to see that?” says Peden. Besides, “I just firmly believe that it’s an unfair responsibility to put on a child.”

What about a case where the kid is, say, 13 years old and a strong swimmer? At what point can supervision wean?

When I ask Denny, who headed the updated technical report on Prevention of Drowning recommendations for the American Academy of Pediatrics, she responds firmly: “If someone is in the pool, they need to be supervised at all times.”

As kids become more competent swimmers, drowning does become less likely, Peden says. But getting older brings other factors into play, such as substance use, swimming in natural (and riskier) bodies of water, and overconfidence. Denny recalls once when her son hopped in the pool at the beginning of a summer and swam across it, a lap he had done in past years. Halfway across, unaccustomed to the swim, he started to sink; she jumped in with her clothes on. After toddlers, adolescent boys are the most at risk of drowning. In fact, at all ages, boys are more likely to die by drowning than girls, usually about twice as often. But once they become teenagers, that jumps to almost 10 times as often.

Because there’s so much variability, it’s important for parents to be aware of the particular risks for their own child depending on their age, gender, race, and location. For example, infants most often drown in tubs or buckets; Black kids have been found to have a higher risk of drowning in hotel pools than other bodies of water (and in general, when compared with other races).

At the end of the day, even strong swimmers—even adults—can drown. Olsen thinks of water safety like driving a car. You might have your seat belt on, but you still need to know how to drive. And even once you learn to drive, you still need to wear a seat belt. And abide by the speed limit. Basically, you need to engage in all the water safety prevention methods, not just rely on one, in order to be safe. In addition to supervision, effective prevention methods against drowning include pool fencing, CPR training, life jackets, and swim lessons.

“It’s probably better to be overbearing,” says Peden, “than have something go wrong and regret that moment and that choice for your whole life.” Olsen agrees: “The only thing more tragic than a death is a preventable death.”