Safety First Summer: The importance of water safety

Original article By Perri Klass, MD featured in the NY Times 

June 4, 2021

Two years ago, I wrote about strategies to prevent drowning deaths in young children, especially in the two age groups where those deaths spike, the toddlers and the adolescents. It’s a perennial topic for those who write about children’s health, because drowning is such a major risk for both those ages — the leading preventable cause of death in children from 1 to 4, and then again in adolescents, especially boys, where it’s the second-most-common cause of preventable deaths from 15 to 19, after car accidents.

That makes drowning a safety issue that’s crucial to review each and every summer, when beach and pool and swimming season comes around, though water safety activists would point out that most of those toddler deaths don’t actually take place while swimming, so there are year-round safety concerns as well. Still, the start of summer, especially after this strange lockdown year, makes for a good moment to review water safety.

When I wrote that column in 2019, I spoke with two mothers who had become water safety activists after losing children to drowning. One was Nicole Hughes, a writing teacher in Bristol, Tenn., whose son, Levi, had been 3 years old when he drowned in a swimming pool at a vacation home, and who has worked with the American Academy of Pediatrics on water safety. The other was Dana Gage, whose son, Connor, had drowned in a lake in Texas at the age of 15, and who founded the LV Project in Connor’s memory to focus on open water and life jackets.

Both of them, like experts across the country, call for a layered approach to water safety, including fences around pools; close, constant and capable adult supervision; swimming lessons; CPR training for parents and caregivers; and Coast-Guard-approved life vests.

I would urge you to read that original article and hear their stories in more detail, but I was also curious to hear their thoughts now, as we move into the summer of 2021, looking back at a year like no other.

The Centers for Disease Control and Prevention has not yet released data on drowning rates for the whole country for 2020, but there were concerns last summer that drowning rates in several states might be higher than usual. Ms. Hughes pointed to the many families who bought pools during the Covid-19 pandemic, but also to the additional stresses on parents who were trying to work from home, and to supervise older children who were learning remotely.

“Toddlers are slipping out unnoticed, reaching the pool more than ever now,” Ms. Hughes said. “The layers of protection really need to be in place.” She has heard stories, she said, about children who drowned the first time they ever climbed out of their cribs, or while families were unloading their groceries.

“It is during the non-swim time when everybody’s loading the car to start the vacation trip,” she said. “When everybody’s watching the kid, then nobody’s watching,” said Ms. Hughes, whose son escaped from a room that contained 12 adults, six of whom were physicians. “Without realizing it, subconsciously you’re letting your guard down when there’s a bunch of people around.”

The essential messages haven’t changed; parents need to be aware of the danger, and they need to understand that this can happen in any family; that small children can move very quickly, and that most home drownings — 70 percent — occur outside of “swim time.” So the layers of protection for toddlers and small children include that supervision, but also four-sided fences around pools, deadbolts on any door that leads to the water, latches placed up high that only an adult can reach.

As children get older, the patterns change, but drowning remains a major risk. And the most important messages for older children involve swimming lessons with water safety competence as an essential life skill to be taught to all children; there are notable disparities in access to swimming lessons, and drowning rates are higher in minority populations. Adult supervision and never swimming alone are still essential, as well as Coast-Guard-approved life jackets, even for strong swimmers. Anyone involved in activities on water where there is a current (tubing on a river, for example) should be wearing one of those life vests.

“So few people are aware that drowning is a big-kid problem too,” said Ms. Gage, who is a member of Families United to Prevent Drowning, which makes many family stories available. “When an older person drowns, it’s typically in open water, and typically there’s a lot of victim blaming.” People look for an explanation that involves reckless behavior, she said, or intoxication. In fact, she said, parents need to understand the importance of continuing to model safe behavior as their children get older. “Wear life vests, just as you don’t get into a car without a seatbelt,” she said. “Just because your child knows how to swim does not mean your child is drown-proof.”

The risk of drowning increases greatly among teenagers, especially boys, and remains elevated into adulthood, and may be tied to risk-taking behaviors. Ms. Gage said that the only laws that regulate life vests are connected to boating — so people tend to assume that there’s no need for life vests in other open water activities. And older children have also been affected by the circumstances of the Covid year, she said, with boat sales having increased and, again, with parents profoundly stressed and sometimes less able to supervise.

Ms. Hughes said that many parents who have been willing to take extreme precautions all year to avoid any chance of their children being exposed to Covid might not realize that statistically, drowning kills more young children — in 2019, 864 children 18 and under in the United States died by drowning, compared to about 300 pediatric deaths from Covid over the course of the pandemic.

Ms. Hughes said she worries that parents encourage children to believe that water is fun. And she said it is not enough to simply warn them about the risks. Since I spoke with her two years ago, she has become a strong believer in the value of swimming lessons for young children.

Some “swim classes” for kids may in fact rely on flotation devices, or on having children swim from one adult to another — which won’t necessarily help if no adult is there, Ms. Hughes said. And those lessons may convey only the message that water is fun, she said, without the attendant warning that it can also be deadly. In an email, she wrote, “When parents are trying to find a swim provider, especially for the age group most at risk (1 to 4), the most important question they should ask the swim instructor is: ‘Will these lessons teach my child how to get to the surface and get oxygen independently?’”

I also checked back with Dr. Benjamin Hoffman, who is the medical director of the Tom Sargent Safety Center at Doernbecher Children’s Hospital in Oregon, and who was one of the authors of the American Academy of Pediatrics policy statement on drowning prevention, asking, among other things, whether there was new research available on successful strategies for keeping children safe. He is looking forward to results from a study in Florida that will look at the effectiveness of classes for children from 3 to 7 years old that specifically teach water survival skills beyond standard swimming lessons, but this research is just getting underway.

With small children, he was worried about the proliferation of backyard pools over the past year, when many community pools were closed because of Covid-19 — and about all the children who missed what would have been a year of swimming lessons last summer. But it wasn’t only pools that were risky during the pandemic; in Oregon, he said, “families sought out lakes and rivers last summer,” where there weren’t lifeguards. This summer, he said, the protective layer of lifeguards may be back again.

“If you’re going to have standing water at home, have constant, close, capable adult supervision when kids are in the water,” and make sure they can’t get to the water when the supervision isn’t there, he said. “Coast Guard-approved life jackets are a good idea for anyone on or in open water,” he said. Kids who grew up swimming in pools may be unprepared for the unpredictable nature of swimming in rivers, lakes or oceans, he said.

Keeping Children Safe at the Beach or Pool June 11, 2018 Dr. Perri Klass is the author of the book “A Good Time to Be Born: How Science and Public Health Gave Children a Future,” on how our world has been transformed by the radical decline of infant and child mortality. @PerriKlass