Cheryl Martin (Host): Drowning is a leading cause of death in children, especially those between the ages of one to four. Here to share some prevention tips is Dr. Tara Smith. She's a pediatric critical care attending physician in the pediatric ICU at St. Joseph's Children's Hospital in Tampa. This is BayCare HealthChat. I'm Cheryl Martin. Dr. Smith, great to have you on this episode.

Dr. Tara Smith: Well, thank you so much for having me.

Cheryl Martin (Host): It's my understanding that Florida leads all states for death from drowning for children ages one to four and ranks fourth in the nation for unintentional drowning deaths for all ages. What are the main circumstances of these drownings?

Dr. Tara Smith: Unfortunately, that statistic is true, and the main circumstances, especially for the kids under five years of age, is that these children just wander away, unbeknownst to the caregivers, the parents, and they get into a body of water, whether it's a pool or a pond, and they end up in the water, and it's just quick and silent, and people aren't aware that they're in there.

Cheryl Martin (Host): So that leads me to, let's talk about key prevention measures. What are some key prevention measures parents can take to keep that from happening or just in general in terms of drownings?

Dr. Tara Smith: So in general, I'll start off by talking about smaller children who are at risk for things like drowning in a bathtub, a bucket of water, even in the toilet. So those are areas where parents just need to be aware. They can't leave kids in a bathtub ever, and if there's water, buckets of water or toilet, it all has to be removed or obviously the bathroom door closed. That's kind of the first thing.

Secondly, for drownings and pools and other bodies of water, what we tell parents is there's really layers of prevention. And hopefully one of these layers will help prevent these kind of tragedies from occurring. So one, the first layer would be to get swim lessons for their children. And we know that this can decrease the risk of drowning significantly as much as 88%. Other preventions include having a fence around the pool. The American Board of Pediatrics recommends a four foot high fence surrounding the pool on all four sides. Have gates to where the pool is that are self-closing.

And then the other level of prevention would be to consider alarms. Alarms that would tell you when somebody entered the pool, alarms and locks on doors and windows. So the door would alarm if the child was heading out to the pool. And that would be another level of prevention.

Cheryl Martin (Host): Now some homes have these inflatable pools. If they’re too big to empty after each use, should they have a fence around them as well?

Dr. Tara Smith: Yes, because anybody could wander into their yard and get into that inflatable pool, and once again, easily drown without anybody really realizing it.

Cheryl Martin (Host): Now, what safety precaution should a parent take when visiting someone with a pool or attending a party where there's a pool?

Dr. Tara Smith: Well, that's a really important point. Parents need to plan for this event, and they need to tell each other like, “Hey, I'll be in charge of watching our toddler today, and I might hand it off to you,” but it would communicate directly. Believe it or not, we hear these stories a lot. People either attend a party where there's a lot of activity going on, and little toddlers slip away, or they actually go to a house for the first time.

It could be grandma's house, it could be an aunt's house. Once again, people aren't paying attention and the kids will wander away. So you need a water watcher. You need somebody specifically watching that little child at all times, so they can't slip away without anyone realizing it.

Cheryl Martin (Host): I'm glad you're talking about this because you're talking about the parents being proactive before they arrive. In almost an essence, having a plan and maybe talking to the host and just not assume that these things will be in place.

Dr. Tara Smith: That's correct. The parents must take responsibility for their safety of their child, and the best way to do it is for themselves to be in charge of that safety.

Cheryl Martin (Host): You mentioned swimming lessons. At what age should a child start those?

Dr. Tara Smith: So even infants start swimming lessons. But I want to make sure the parents understand that having swimming lessons doesn't prevent  drowning. Not to be too reassured that's going to prevent drowning. But it's important for all kids to understand, especially for kids that can think about what they're doing and what's happening, to know that you should never swim alone, that you should never enter the water by yourself, that you should never dive into water that you don't know the depth of it. The rule would be to enter water feet first, which would prevent spinal injuries to the cervical spine, or even the head trauma

if they dive into a pool that's very shallow and they didn't realize it. So almost all ages can get swimming lessons and swimming safety rules.

Cheryl Martin (Host): But beginning you believe at what age?

Or does it just depend on the child?

Dr. Tara Smith: It depends on the child, it depends on the parents, but I know even little infants of six months of age get swimming lessons in the water and learn how to come up out of the water.

I think toddlers and older kids would be more likely to benefit from those kinds of swimming lessons.

Cheryl Martin (Host): When you mention those instructions to children, at what age do they comprehend those?

Dr. Tara Smith: Well, I think the sooner you learn those kinds of lessons, the more it'll be ingrained in their everyday activities. If you're a two and three-year-old and an instructor tells you every day, "Never go in the pool by yourself, you always have to be with a buddy, you always have to tell your parents if you're in the water.”

I think they'll begin to make that as part of their normal activity around water. So I don't think you can give that information too early.

Cheryl Martin (Host): Is it true that kids with autism are at increased risk of drowning? What tips do you have for parents of kids with autism or special needs?

Dr. Tara Smith: This is a very specific population of kids, and it turns out the National Autism Association has reported that kids with autism are 160 times more likely to die from drowning than the general population. So in this community, it is extremely important to start swimming lessons as soon as possible, to go over all the safety tips and to use all the other barriers that we've talked about, including blocks and fences and alarms.

Cheryl Martin (Host): You mentioned early on about safety in the home. Any other suggestions for safety in the tub with infants and just in the bathroom in general?

Dr. Tara Smith: So in the tub with infants, for parents, they just should never be distracted. They can't get up and answer the door. They can't answer their phone. They certainly can't walk away and thinking, “Oh, there's maybe an older child in the tub,” that's notgoing to be protective. And so they just have to be with the child until the bath time is over. And obviously toilets should be closed at all times so no one can accidentally fall in and drown.

Cheryl Martin (Host): And just never, ever leaving the infant correct?

Dr. Tara Smith: That is correct.

Cheryl Martin (Host): Talk about the difference it can make when parents are educated or informed regarding drowning prevention and understand the risks of being near pools and other bodies of water.

Dr. Tara Smith: I think the more knowledge parents have about drowning prevention and some of the safety features that we've been talking about can literally save lives. So it's just so important to get this information out to the community 'because I don't think people realize what a common and unfortunate event that this can be for their lives.

Cheryl Martin (Host): What are you seeing in the hospital as a critical care doctor?

Dr. Tara Smith: So as a critical care doctor, what we see is, when the drowning happens, oftentimes the result of being submerged under a liquid, you are unable to breathe and you're unable to get oxygen to your body. That eventually will lead to both cardio and respiratory arrest. So often we see  patients coming into us after they've had a period of resuscitation.

They get CPR and they might have it for 20 minutes, it could be 15 minutes, it could be even longer than that. And so patients will come into us with pretty severe neurologic changes because unfortunately, not having oxygen get to your brain can cause pretty severe brain damage. Many of these children actually go on to their death,

basically from the brain damage that has occurred, they can have brain death. Having a submersion injury actually negatively affects every single one of our organs, our heart, our lungs, our kidneys, our liver. And often some of those organs can recover. But what can't recover is our brain. Once you lose brain cells, there's not a way of getting them back.

And one of the unfortunate things, when you have a brain injury, the response of the brain after that injury is to swell, and it can swell pretty severely over the following 48 to 72 hours. And that's when we see these children lose their lives after they've had this submersion injury, as we call it.

Cheryl Martin (Host): Now another sad story that we have heard over the years is at the beach and hearing of children drowning or rescue efforts. What prevention tips do you have for parents at the beach?

Dr. Tara Smith: So at the beach, similar kinds of things. Children should never swim alone. They should always have somebody out there in the water with them. We suggest parents should always be within an arm's reach of their children in case there's any problem that's at the pool or at the beach. Obviously, things to know about are things like rip currents that just kind of

sweep people out farther away from the beach and then they have difficulty getting back. And so knowing about rip currents, knowing to try to swim parallel to the beach to try to get back in. But really, parents must be near their children to try to prevent some of these issues and be aware of some of the conditions in the water for that day.

Cheryl Martin (Host): Dr. Smith, anything else you'd like to add on this vital topic?

Dr. Tara Smith: The only other thing that I didn't mention is another layer of safety is that it's a good idea for parents to get CPR training. So if God forbid something horrible did happen, you'd be able to start resuscitation for your child immediately, if you had to pull them out of the water.

Cheryl Martin (Host): Dr. Tara Smith, thank you for sharing your tips and insights on what parents can do to keep their children from a drowning incident. Very practical and informative. Thank you.

Dr. Tara Smith: Thank you.

Cheryl Martin (Host): That wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers.

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