We’ve all seen a drowning onscreen: The sudden screaming. The flailing and splashing. The sheer terrifying drama of it all. In real life? Not so much. Kids often drown without a struggle—or even a sound.
And in the vast majority of drownings, studies show, the child is being watched by a parent or other relative.
Not to cast a shadow on your summer fun, but only car crashes kill more kids under age 14. Among toddlers and preschoolers, drowning is the #1 kind of injury death. And for every child who drowns, five more go to the E.R. for related—and not necessarily minor—injuries, like brain damage.
The two best things for preventing drowning: our eyes
We’ve all heard the list of things that can help keep kids safe, like fencing around pools, not relying on floaties or water wings for safety, and giving kids swimming lessons, starting as young as ages 1 to 4, according to the CDC. Multiple layers of protection are ideal, safety experts stress.
(Water wings, for example, only keep the arms—not the face—out of the water, and can slip off, shift position, or lose air. They also hinder kids’ ability to learn the right body and arm positioning for real swimming.)
But no matter what the combination, the one unbeatable “must” that everybody agrees on is eyes-on-kids supervision—and, importantly, knowing what to look for.
Consider these different—and surprising—ways that drowning can happen (and how you can prevent it):
These drownings happen when kids hold their breath under water. (Why would they do that? Because they’re kids! They goof around. They compete. And they play random games, like holding their breath under water.)
What happens: On top of the lack of oxygen, lower-than-normal carbon dioxide levels fail to trigger the person to breathe. So they don’t realize they’re about to black out and don’t even struggle.
The takeaway: Break up breath-holding games if you see them—in the bathtub as well as a pool or lake. It’s also smart to avoid repetitive under-water laps—the swimmer should rest in between and take a breathing lap. Don’t let kids swim alone.
Learn more: ShallowWaterBlackoutPrevention.org was founded by Rhonda Milner, whose son Whitner—a strong swimmer—died alone in his family pool while training to hold his breath for three minutes.
Secondary drowning (or delayed drowning)
What’s unnerving here is that the child isn’t even necessarily still in the water. The drowning happens after a time lag. You should know, though, that this is pretty rare—you don’t have to worry about drowning sneaking up on you every time your kid goes in the water; it almost always follows an obvious scare.
What happens: The child inhales some water—maybe while getting dunked or after falling in. It’s not enough water to keep the child from breathing, maybe just enough to cause a lot of coughing and sputtering. But within the next one to 24 hours, fluid seeps back into the lungs and the body fights it, like pneumonia.
The takeaway: If you notice your child going under or swallowing water and having trouble catching breath, watch for any further signs of breathing difficulty that may show up later. Those signs might include flaring nostrils, rapid and shallow breaths, gasping, making choking sounds while sleeping, or otherwise not acting normally. Sudden lethargy is also a danger sign, but that can be tricky, since kids are often tired after a swim day—so experts advise watching for this in connection with other concerning signs if there’s been a scary incident.
Any child who’s had a water rescue should also be checked out by a doctor—usually with a chest x-ray to look for water in the lungs.
Learn more: Here’s a doctor’s account of a child she suspected had secondary drowning.
Surprisingly often, kids drown in plain view of other bystanders. That’s because a child typically struggles for just 20 seconds before sinking, according to the Journal of Emergency Medical Services, compared to a minute for an adult.
What happens: After a short bit of distress thrashing—or none at all—something called the “instinctive drowning response” kicks in. It’s the body’s way to save itself when drowning. There’s no yelling; it becomes impossible in order to conserve breath for breathing. The arms rest on the surface of the water to better lift the head up and breathe, so they can’t wave for help. They can’t even kick or move their body toward help.
They just quietly sink.
The takeaway: Keep your eyes on a young child in the water—even if the child is wearing a flotation device or has had swim lessons. Don’t necessarily expect a lot of commotion to alert you to trouble. Check out a child who doesn’t seem to be moving around much or splashing, whose head is tilted back and mouth almost level to the water. They may not even be able to respond to being asked, “Are you okay?”
Learn more: It really helps to know what you’re watching for. This news report features the man who identified the instinctive drowning response. Here are more demonstrations of what to look for and do.
You may also hear this term. In as many as 1 or 2 of every 10 cases, the drowning is a type of suffocation. Water never enters the lungs; thus the name “dry.” (Confusingly, delayed drowning, described above, is also sometimes mistakenly called “dry drowning” because it often happens later, on dry land.)
What happens: If water is inhaled, the larynx (voice box) can spasm shut. That forms a vacuum, making it impossible to release air or take in fresh air—or call for help. (In most conventional drownings, the larynx relaxes and the lungs fill with water; in both cases, without help, the outcome is the same.)
The takeaway: Teach kids to keep their mouths closed when plunging into the water. But because dry and conventional drowning (where water gets in the lungs) are basically the same in terms of how to prevent them and their potential outcome, most experts no longer distinguish between “dry” or “wet” drowning. The advice is the same: Make sure kids know to alert someone if they see a swimmer in distress.
Learn more: In April 2016, the American Academy of Family Physicians summarized why all the various terms for drowning demand our vigilance.
What all these situations have in common:
- They can happen to anybody—whether kids have learned to swim or not.
- They don’t happen so often that you should be afraid of getting your kids in the water. The benefits of swimming and water play far outweigh the risks!
- Eyes-on supervision isn’t optional—especially for babies, toddlers, and preschoolers, and older kids who aren’t experienced swimmers. You can’t count on noise and ruckus to alert you to problems, which is why sitting poolside with an iPad or your phone is a bad idea. Most 1- to 4-year-olds drown in swimming pools.
A brilliant life-saving idea
Just as we all grew up with Designated Drivers to prevent drunk driving, think about having a “Designated Water Watcher” when kids are swimming or playing around a pool or other body of water.
One great idea for parties or groups at the pool or beach: Make up a Water Watcher tag or card that one adult physically wears or holds to show they’re on duty. Rotate the responsibility every 15 to 20 minutes. (It gets harder to focus closely after much longer.) This person not only should avoid using devices or reading but shouldn’t be drinking.
When there are multiple adults around, it’s easy to think “somebody else” is keeping a close watch on kids. A rule of thumb that safety experts like to quote: “If everybody is watching, nobody is watching.”