Transcription:

Lindsay Clukies, MD (Guest): Hi. I'm Dr. Lindsay Clukies, a Washington University emergency medicine pediatrician and a mom doc at St. Louis Children's Hospital.

Melanie Cole, MS (Host): Welcome. This is Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole and today we’re talking about drowning. Dr. Clukies, tell us a little bit about where most drownings happen. Are they in a home pool? A public pool? In lakes or oceans or even in bathtubs? Where do they mostly happen?

Dr. Clukies: Yeah, sure. Thanks for having me on today. So infants under the age of one are most likely to drown in a bathtub. I think that it’s really important to note that it’s not even necessarily a bathtub that’s filled to the top. Infants can drown in any type of water less than two inches high. So infants less than one, they’re most likely to drown in a bathtub. As children get older, the likelihood of drowning in natural water settings like lakes or oceans and rivers increases with age. Most children ages one through four of age—so your toddlers—they're more likely to drown in any type of home swimming pool or spa.

I think it’s really important to note that the majority—so a little under 70% of drownings—happened when children were not expected to be swimming. So they weren’t at a waterpark or in a pool or boating. They were found in water when they were not supposed to be water. So any types of bathtubs or toilets or buckets, et cetera. Any type of body of water greater than an inch deep are drowning risks. Children are curious, they look around. So what exactly does this mean? It means that drownings can happen quickly and quietly. So, in fact, most children who drown were out of sight for less than five minutes. Depending on the water temperature, the entire process can take as little as a few minutes. So prevention and supervision is key.

Host: Well, I think that’s going to be our main message today. As a mother of two, Dr. Clukies, I can tell you that when my son was really little—two or three—and we had one of those blow up pools on the deck, I turned my head for two seconds, just turned. I was right there, I turned. When I turned back around, it was like in slow motion. The side caved in; in he went. I mean it happened so fast. I know that’s our main message today is supervision. What would you like us to know is the most important thing about children and water—any type of water—and what you want us to know.

Dr. Clukies: Yeah. I think you make a great point. It really can happen in seconds. There’s a story that’s publicized in the media right now of a family, of a three year old boy who unfortunately drowned last summer. They're happy for me to talk about it because they want to get a lot of prevention information out there. He was staying at a house with six physicians and was not meant to be swimming. His mom was sharing a brownie with him. Before she even finished her half of the brownie, he had drowned in the pool. So, again, it can be seconds.

I think it’s really important to stress that there must be multiple barriers to help prevent drowning. So nothing can replace supervision. That’s the bottom line. It doesn’t matter if there’s a lifeguard there, if there’s floaties on a patient. The most important thing is for caregivers to be supervising any child in any type of water. So there are a few things that I recommend. The first is something called water guardian tags. So there’s a lot of foundations out there that have created actual water tags for caregivers to wear when they are in charge of supervising children at that point. It just says, in big font, it says water guardian.

I also like the term touch supervision. So I mean everyone’s human. Distractions can happen. I think it’s important to remember to keep your child within range of our touch in or around any type of water. So with infants, toddlers, and young children an adult should always be within an arm’s length. I think if you have a pool, there have to be rules and regulations set. So you have to make sure that kids do not run or push each other around a pool. You never want them diving in areas that are not marked for diving. Children must get out of the pool right away in any type of bad weather.

Also I think having a fence is extremely, extremely important. So a four-sided fence at least four feet high is what I recommend. The fence should have a self-latching self-closing gate to ensure that it always stays closed and that toddlers and young children cannot open it themselves. There should be no openings or protrusions that a young child could use to get over or under a fence. Again, children are curious and there’s been stories of children climbing above the fence and unfortunately drowning. There are things on the market such as pool alarms and door alarms and other retractable pool covers. I think they are additional layers of protection, but, again, they cannot take place of a fence and most importantly direct adult supervision.

Host: People tend to think, doctor, that floatation devices or even swimming lessons. Please speak for us on things like those little floating arms now. As someone who goes to a lake quite a lot, life jackets are the only thing. My kids have to wear them pretty much all the time. Other people I see have those little arm floaties. Are those considered safe? What about swimming lessons? Does that make it so that our children are less likely to drown?

Dr. Clukies: So floatation devices will not prevent drowning 100%. That’s the simple answer. Again, and I'm going to sound like a broken record, but nothing can replace direct adult supervision while children are in or around water. The longer answer is that life jackets are a most. So I recommend coast guard approved life jackets at all times when on boats or docks or really near any body of water. It’s important that the device fits properly. So it shouldn’t be too loose. It should be properly strapped and belted.

I don’t recommend the use of air filled swimming aids. So those are the Puddle Jumpers or the water wings that you mentioned. Those are the things that we commonly see children at community pools or at the lake wearing. So they can deflate easily. If they pop, they're not doing anything. The other thing is they're not designed to keep swimmers safe. So they don’t ensure that a child’s head is always kept above water. The other thing is they can, unfortunately, give children and caregivers a false sense of security.

I think swimming lessons is a good topic to talk about. So there is research out there that swim lessons are beneficial for children. I think it’s important that really everyone knows how to survive in water. So basic swim skills are important, and children do need to learn how to swim. I think the most important things they should know is how to float, how to control their breathing, and they should be practicing not panicking and how to traverse a distance in water. There is some research that shows that children over the age of one may be at lower risk of drowning if they have had some type of formal swimming instruction. That being said, there’s no evidence or research that shows that swimming lessons or water survival skills can prevent drowning in babies younger than one year of age. So don’t go rushing to put your infant in swimming lessons by any means.

Again, I know I sound like a broken record, but swimming lessons do not replace adequate water safety. Even the best swim lessons and swimmers cannot drown proof a child. So the American Academy of Pediatrics strongly recommends that parents take steps to make a child’s environment safer and don’t just rely on swim lessons.

Host: So important. Now, we’ve heard of the time dry drowning. Is that real Dr. Clukies? If it is, then what is it and how does it happen?

Dr. Clukies: Yeah. Dry drowning is a really hot topic right now and something we’re asked about a lot in the emergency department. So it’s important to know that dry drowning is not an approved medical term. Terms such as near drowning or dry or wet drowning should be avoided. There’s been a lot of misinformation circulated in recent years regarding dry drowning and secondary drowning, and, again, we don’t want to use these terms. So often times these terms are used to refer to delayed symptoms experienced after submersion or emersion in water. So it does not mean that your child can drown on dry land. The good news is that there are always warning signs. So I want to stress that caregivers will see warning signs if a child has any complication from a submersion injury in water.

Children who have had these events either get better or worse within a few hours after the event. Those things to look for include cough, difficulty or rapid or fast breathing, excessive sleepiness, wheezing, any changes in behavior, vomiting, et cetera. Any time you're concerned about your child and think he or she could have any of these signs or symptoms, please, please seek medical care. I recommended going immediately to our pediatric ER for evaluation if any of these symptoms develop.

Host: That was a great explanation. Thank you so much for clearing that up for us. So as we wrap up, give us your best water safety tips for the summer, Dr. Clukies. You know people are having home pool parties. Do we let our kids go to those things without us? Do we call the parents to make sure the situation? What do you want us to know is some of the most important things we can do to keep our kiddos safe?

Dr. Clukies: Yeah. I would absolutely call anyone hosting a pool party because a lot of variables go into these decisions. So how old is your child? Who else is in the pool? Is your child a confident swimmer? I do feel strongly that a child who cannot swim should not be unattended at a pool party. You want to know how many children will be there. The more people are in the pool, the more likely there to be distractions, potential trouble, and the harder it is to supervise them.

I think there are a lot of important questions to ask the host of the pool party. So first of all, how many adults will be supervising the pool party? Importantly, are the people who are supervising the children trained in CPR? So it is absolutely essential to have a CPR trained person supervising children, and the supervisor should not be easily distracted or under the influence of any alcohol or other drugs. Again, for younger children, designating a responsible adult as the water guardian. Really, the most important message I want listeners to take away today is that again and again nothing is safer than direct supervision of children by CPR trained adults in any type of water. Having multi-layer physical barriers and close supervision is the best strategy to keep your children safe. So drowning is actually one of the leading causes of accidental death in children and it’s 100% preventable.

Host: Thank you so much Dr. Clukies for coming on today and giving us such important information. That wraps up this episode of Mom Docs with St. Louis Children's Hospital. Head on over to our website at stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast informative as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I'm Melanie Cole.