Which pediatric population has the highest rate of drowning?

From the Guidelines

Children aged 1-4 years have the highest rate of drowning among pediatric populations. This age group is particularly vulnerable due to their developing motor skills, natural curiosity, and inability to recognize danger, as highlighted in the 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning 1. Toddlers can drown in as little as 2 inches of water, and drowning often occurs quickly and silently. For these young children, most drownings happen in home swimming pools, bathtubs, and other bodies of water around the home.

Some key factors that contribute to the high rate of drowning in this age group include:

• Developing motor skills that make it difficult for them to escape from water
• Natural curiosity that leads them to explore their environment, including water
• Inability to recognize danger, such as the risk of drowning
• Limited ability to call for help or alert others in case of an emergency

Prevention strategies should include:

• Constant adult supervision without distractions when children are in or near water
• Installation of four-sided pool fencing with self-closing and self-latching gates, as recommended by the 2024 American Heart Association and American Academy of Pediatrics focused update 1
• Use of proper flotation devices (not inflatable toys)
• Teaching basic water safety skills, such as swimming lessons, especially for children and non-swimmers
• Ensuring close and active supervision of weak or nonswimmers in and around water, as emphasized in the 2024 update 1

Parents and caregivers should also learn CPR, as immediate resuscitation efforts significantly improve outcomes for drowning victims, as noted in the 2024 American Heart Association and American Academy of Pediatrics focused update 1 and the 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning 1.

From the Research

Pediatric Population with the Highest Rate of Drowning

• The pediatric population with the highest rate of drowning is children under the age of 4 years, with males being overrepresented in most series of pediatric drowning 2, 3, 4.
• According to a study published in 2005, males and preschool-aged children are overrepresented in most series of pediatric drowning, with 57% of cases occurring in the 0- to 4-year age group 2.
• Another study published in 2023 found that the incidence of drowning peaks among children aged 1-4 years and again in adolescence 3.
• A retrospective multicenter study involving eight Italian Pediatric Emergency Departments found that younger males had a higher rate of ICU admission than female peers, with a median age at the event of 5 years 5.
• Nationally, children under the age of 4 years and male adolescents represent the pediatric groups with the highest rates of drowning, with boys being involved more than 2 times as often as girls for all childhood ages assessed 4.

Key Factors Contributing to Drowning

• Age and gender are significant factors contributing to drowning, with males and preschool-aged children being at higher risk 2, 4.
• The location of drowning, such as open water or pools, also plays a role, with children drowning in open water being significantly older than those drowning in pools 2.
• The presence of preexisting medical conditions, such as epilepsy, can also increase the risk of drowning 5.
• Prompt intervention, including cardiopulmonary resuscitation, is crucial in preventing drowning deaths, with no difference in outcomes seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services 5.