Child Drowning

esult, children fall in and drown, or get into trouble while playing in the water. Usually they are alone
or with peers who also cannot swim and lack safe rescue skills. Attempted rescue by peers frequently
leads to a multiple drowning where the rescuer and the child whose rescue is attempted both drown.
The context as well as place of water recreation differs between LMICs and HICs. Aquatic recreation and
recreational settings in both groups of countries have a formal component (e.g. going to beaches,
swimming pools, water parks, marinas) where recreation is planned in advance. There is also an
informal component (e.g. playing in a pond, or swimming in a river) that is spontaneous. The relative
proportion of each is very different in each setting − HICs have much larger formal components and
LMICs have much larger informal. In formal recreational settings, the ability to plan ahead provides
prevention measures that are not available or feasible in informal settings. For example, parents who
plan to send their children boating are able to ensure they wear life jackets; those who know their
children are going to the beach can ensure a lifeguard is on duty and there is nearby adult supervision.
When recreational activities are unplanned and spontaneous, as is usually the case for recreation in
LMICs, there is no opportunity to take such precautions as the child spontaneously decides to play near
or in the water and the parents are not aware of it. Even when recreation is planned ahead in LMICs,
there are other basic differences: parents are usually unaware of the risks of drowning as well as what
precautions should be taken; even if parents are aware, there are often no lifeguards at beaches or
other swimming sites, no life-jackets on boats, and adults who supervise children often do not know
how to swim, conduct a safe rescue or conduct cardiopulmonary resuscitation (CPR).
(iii) Supervision, alcohol use and training in rescue and resuscitation
There are other differences in recreational settings as well. In LMICs, primary school-aged children (six
to nine years old) and older children are commonly not supervised by adults. It is the norm in most
LMICs for school-aged children to play alone or unsupervised by adults. In contrast, in most HICs
children are usually supervised by adults well into adolescence.
Alcohol is commonly a contributing factor in recreational drowning incidents in HICs. However, in LMICs,
the ages of drowned children (most are under five and would not be using alcohol) and cultural factors
such as religion (many LMICs are predominantly Muslim) mean that alcohol is rarely a contributing
factor. 33
Another major difference is the very low prevalence of peers or bystanders with rescue and
resuscitation training, as well as the total lack of emergency medical response in rural LMIC
communities. A child who drowns in an HIC is much more likely to be rescued or resuscitated, or both,
than a child who drowns in the LMICs surveyed. 34
33 Wintemute, G.J. et al. (1990). ‘Alcohol and Drowning: An analysis of contributing factors and a discussion of criteria for case
selection’. Accident Analysis and Prevention, 22:291-296; Howland J. and R. Hingson (1988). ‘Alcohol as a Risk Factor for
Drowning: A review of the literature (1950–1985)’. Accident Analysis and Prevention, 20(1):19-25.
34 Kyriacou, D.N. et al. (1994), ‘Effect of immediate resuscitation on children with submersion injury’. Pediatrics, 94:137–142;
Wigginton J. ‘The key role of layperson actions in drowning incidents’. In: World Congress on Drowning, Amsterdam, 26–28 June
2002. Amsterdam, Consumer Safety Institute, 2002; Marchant J. et al. (2008). Bystander basic life support: an important link in
the chain of survival for children suffering a drowning or near-drowning episode, Medical Journal of Australia, 189 (1):56;
Venema A, et al (2010), ‘The role of bystanders during rescue and resuscitation of drowning victims’. Resuscitation, Volume 81
Issue 4, pages 434-439.
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