The death rate from drowning among children ages 14 and under declined 37 percent from 1987 to 1997.However, drowning remains the second leading cause of unintentional injury-related death in this age group and the leading cause of unintentional injury-related death among children ages 1 to 4.The majority of drownings and near-drownings occur in residential swimming pools. However, children can drown in as little as one inch of water and are therefore at risk of drowning in wading pools, bathtubs, buckets, diaper pails, toilets, spas and hot tubs. Additionally, older children are more likely to drown in open water sites, such as lakes, rivers and oceans.

Drowning usually occurs quickly and silently.Childhood drownings and near-drownings can happen in a matter of seconds and typically occur when a child is left unattended or during a brief lapse in supervision.Two minutes following submersion, a child will lose consciousness.Irreversible brain damage occurs after four to six minutes and determines the immediate and long-term survival of a child.  The majority of children who survive are discovered within two minutes following submersion (92 percent), and most children who die are found after 10 minutes (86 percent).Nearly all who require cardiopulmonary resuscitation (CPR) die or are left with severe brain injury.

DEATHS AND INJURIES

• In 1997, nearly 1,000 children ages 14 and under drowned.Children ages 4 and under accounted for more than half of these deaths.
• Near-drownings have high case fatality rates. Fifteen percent of children admitted for near-drowning die in the hospital.As many as 20 percent of near-drowning survivors suffer severe, permanent neurological disability.
• For every child who drowns, an additional four are hospitalized for near-drowning and for every hospital admission, approximately four children are treated in hospital emergency rooms.

WHEN AND WHERE DROWNINGS AND NEAR-DROWNINGS OCCUR

• More than half of drownings among infants (under age 1) occur in bathtubs.Drownings in this age group also occur in toilets and buckets.
• More than 85 percent of drownings among children ages 1 to 4 are pool-related.
• Children ages 5 to 14 most often drown in swimming pools and open water sites.
• More than 327 children, 89 percent between the ages of 7 and 15 months, have drowned inbuckets containing water or other liquids used for mopping floors and other household chores since 1984.
• Approximately 10 percent of childhood drownings occur in bathtubs; and the majority of these occur in the absence of adult supervision.
• Among children ages 4 and under, there are approximately 375 residential swimming pool drownings and 2,900 near-drownings requiring hospital emergency room treatment each year. More than half of these drownings occur in the child's home pool and one-third at the homes of friends, neighbors or relatives.
• The majority of children who drown in swimming pools were last seen in the home, had been missing from sight for less than five minutes, and were in the care of one or both parents at the time of the drowning.
• In-ground swimming pools without complete four-sided isolation fencing are 60 percent more likely to be involved in drownings than those with four-sided isolation fencing.
• Since 1980, approximately 230 children ages 4 and under have drowned in spas and hot tubs.
• In 1998, 17 children ages 14 and under drowned in boating-related incidents.
• In 1998, more than 210 children ages 14 and under suffered personal watercraft-related injuries while on the water.
• Drownings and near-drownings tend to occur on Saturdays and Sundays (40 percent) and between the months of May and August (66 percent).
• Drowning fatality rates are higher in southern and western states than in other regions of the United States.Rural areas have higher death rates than urban or suburban areas, in part due to decreased access to emergency medical care.

WHO IS AT RISK

• Children ages 4 and under have the highest drowning death rate, a rate two to three times greater than other age groups, and account for 80 percent of home drownings.These drownings typically occur in swimming pools and bathtubs.
• Male children have a drowning rate two to four times that of female children.However, females have a bathtub drowning rate twice the rate of males.
• Black children ages 14 and under have a drowning death rate that is two times greater than white children, in general and six times greater for drownings in buckets.However, white children ages 1 to 4 have a drowning death rate that is twice that of black children, primarily from residential swimming pool drownings.
• Low-income children are at greater risk from non-swimming pool drownings.
• Among children hospitalized for near-drownings, prolonged submersion and time until resuscitative efforts are initiated, as well as hypothermia, are strongly associated with poor outcomes.

DROWNING PREVENTION EFFECTIVENESS

• Installation of four-sided isolation fencing, at least five feet high, equipped with self-closing and self-latching gates, could prevent 50 to 90 percent of childhood residential swimming pool drownings and near-drownings.Door alarms, pool alarms and automatic pool covers, when used correctly, can add an extra level of protection.
• It is estimated that 85 percent of boating-related drownings could have been prevented if the victim had been wearing a personal flotation device (PFD).In 1998, less than one-fourth of the children ages 14 and under who drowned in boating-related incidents were wearing PFDs.
• Educational efforts focused on PFDs and safe boating practices are effective in increasing PFD usage.

WATER SAFETY LAWS AND REGULATIONS

• The U.S. Consumer Product Safety Commission has developed voluntary guidelines, which include both education and labeling, to address the hazard of children drowning in five-gallon buckets.
• Three states (Arizona, California and Oregon) and many communities have enacted safety laws requiring fencing around residential swimming pools.
• At least 32 states have enacted boating safety laws requiring children to wear PFDs at all times when on boats or near open bodies of water.These laws vary in age requirements, exemptions and enforcement procedures.
• Recreational boats must carry one U.S. Coast Guard-approved PFD in good condition and the correct size for each person aboard.A properly sized PFD must be available, serviceable and accessible.

HEALTH CARE COSTS AND SAVINGS

• Typical medical costs for a near-drowning victim can range from $75,000 for initial emergency room treatment to $180,000 a year for long-term care.The cost of a near-drowning that results in brain damage can be more than $4.5 million.
• The total annual cost of drownings and near-drownings among children ages 14 and under is approximately $6.2 billion.Children ages 4 and under account for $3.8 billion, or 61 percent, of these costs.

PREVENTION TIPS

• Never leave a child unsupervised in or around water in the home.Empty all containers immediately after use and store out of reach.
• Never leave a child unsupervised in or around a swimming pool or spa, even for a moment.Never rely on a PFD or swimming lessons to protect a child.Learn CPR and keep rescue equipment, a telephone and emergency numbers poolside.
• Install four-sided isolation fencing, at least five feet high, equipped with self-closing and self-latching gates, that completely surrounds swimming pools or spas and prevents direct access from a house and yard.
• Always wear a U.S. Coast Guard-approved PFD when on a boat, near open bodies of water or when participating in water sports.Air-filled swimming aids, such as "water wings," are not considered safety devices and are not substitutes for PFDs.
• Never dive in water less than nine feet deep.

This information was compiled by the National SAFE KIDS Campaign.