(CNN) — Drowning is the leading cause of death among children ages 1 to 4 in the United States, and it’s getting worse.
After years of declining rates, child drowning deaths have increased since the Covid-19 pandemic, perhaps because of disruptions to swimming lessons and public pool access. This trend has renewed concern among pediatricians and parents.
These tragedies are largely preventable when families and communities use multiple layers of protection, according to a recent American Academy of Pediatrics report that reviewed the latest evidence on drowning prevention.
To help understand what parents and caregivers should know, I spoke with CNN wellness medical expert Dr. Leana Wen, who is also the mother of two young children. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore’s health commissioner.
CNN: Why is this issue receiving renewed attention now?
Dr. Leana Wen: This report is a comprehensive review of the scientific evidence on drowning prevention. The authors evaluated decades of research on who is at highest risk of drowning and what interventions have been shown to save lives. They also provided updated recommendations for families, healthcare providers and policymakers.
Drowning remains a major public health problem. In toddlers and young children, drowning is the most common cause of death, surpassing birth defects. Among children ages 5 through 14, drowning is second only to motor vehicle crashes of unintentional injury deaths. In 2024, 1,075 children and adolescents younger than 20 died from unintentional drowning, including watercraft-related incidents.
Many of those deaths were preventable. One of the report’s central messages is that preventing drowning requires multiple layers of protection, including close supervision, swimming skills, barriers around pools, life jackets and policies that improve water safety. When these safety measures are used together, the risk of drowning falls substantially.
CNN: Many people picture someone yelling for help and splashing wildly when they think about drowning. Is that what drowning actually looks like?
Wen: Usually not — and this is a key misconception to correct. In fact, drowning is often surprisingly quiet. A child who is struggling in the water is typically focused on trying to breathe. They usually cannot wave their arms or call out for help because they are using all their energy trying to keep their mouth above water. When someone is in trouble, they may bob vertically and appear to be trying to climb an invisible ladder or just slip beneath the surface.
That’s why experts emphasize active, undistracted supervision. Whenever possible, children should swim in locations with lifeguards since trained personnel can recognize distress quickly and initiate rescue if needed. Even then, parents and caregivers should not rely on the lifeguard alone, especially for children with weak swimming skills.
Many organizations recommend assigning a designated “water watcher” whenever young children are in or near the water. That person’s only responsibility is watching the children — not stepping away to talk with friends or scrolling through a phone.
This recommendation also addresses a tragically common circumstance surrounding childhood drownings, when multiple adults are present and each assumes someone else is watching the child. Do not make that assumption. Clear communication about who is responsible for supervision can prevent these lapses.
CNN: If parents could take just a few steps to reduce the risk of drowning, what would you put at the top of the list?
Wen: The first is close, constant supervision. For toddlers and young children, that means staying within arm’s reach whenever they are in or around water. Even a brief distraction can be enough for a child to wander into a pool and out of eyesight.
Second, every residential pool should be protected by four-sided fencing that completely separates the pool from the house and yard. The fence should have a self-closing, self-latching gate and be at least 4 feet tall. Research has consistently shown that this type of fencing is one of the most effective ways to prevent young children from gaining unsupervised access to pools.
Third, use properly fitted, US Coast Guard-approved life jackets whenever children are boating or swimming in lakes, rivers or other natural bodies of water. Natural bodies of water can be unpredictable, and life jackets provide an important layer of protection even for people who are confident swimmers.
CNN: When should children begin swimming lessons? Can learning to swim eliminate the risk of drowning?
Wen: The American Academy of Pediatrics recommends that most kids should start learning to swim by the time they are 4 years old. They could certainly begin swim lessons earlier, especially for families that have a pool at home, live near a pond or lake, or use a boat regularly.
Research has shown that formal swimming lessons substantially reduce drowning risk among young children. Swim lessons can teach valuable water safety skills and increase confidence in the water, but they do not eliminate risk.
CNN: Do drowning rates differ across racial and ethnic groups? If so, why?
Wen: Among people younger than 30 years, drowning death rates are highest among American Indian and Alaska Native individuals, followed by Black individuals, according to the AAP report. Among children ages 5 to 19, Black children were 5.5 times more likely to drown in swimming pools compared with White children.
The report emphasizes that these disparities are not due to biological differences. Instead, they likely reflect longstanding historical and structural factors that influence access to swimming lessons and opportunities to develop swimming skills. In some communities, generations of families have had fewer opportunities to learn to swim because of barriers to accessing pools and other aquatic facilities. Expanding affordable swim instruction and access to safe places to swim could help reduce these inequities.
CNN: Does water safety advice change depending on where you’re swimming?
Wen: Yes. Young children most often drown in residential swimming pools, whereas adolescents are more likely to drown in natural bodies of water. Lakes, rivers and the ocean pose additional hazards, including currents, changing depths and underwater obstacles, so families should take extra precautions when swimming there.
It is always safest to swim where lifeguards are on duty. Before entering the water, ask the lifeguards about local hazards, including currents, tides, water quality or other conditions that could make swimming unsafe. Pay attention to weather forecasts and always heed warning flags.
Never swim alone. This is especially important for teenagers, who may overestimate their swimming ability or take unnecessary risks. Also, never swim after drinking alcohol or using marijuana or other substances that can impact alertness.
CNN: Many products are marketed to parents, including wearable alarms, pool alarms and inflatable flotation devices. Which of these actually help?
Wen: Some of these products can add another layer of protection, but none should be considered a substitute for supervision and physical barriers to swimming pool access.
For example, wearable immersion alarms and pool alarms may alert caregivers after a child enters the water, but they don’t prevent a child from getting into the pool in the first place. Likewise, inflatable arm bands, rings, pool noodles and other novelty flotation devices are toys, not lifesaving equipment. Children wearing them or using them need constant supervision and should never be left unattended in or near the water.
CNN: What should someone do if they witness a drowning?
Wen: First, get the person out of the water if you can do so safely. If you’re not a trained rescuer, avoid putting yourself in danger. Call 911 immediately or direct someone else to call while rescue efforts are underway.
Once the person is out of the water, check whether they are breathing and have a pulse. If not, begin cardiopulmonary resuscitation (CPR) immediately and continue until emergency medical personnel arrive. When drowning occurs, every minute without oxygen increases the risk of permanent brain injury or death.
For that reason, I strongly encourage parents, grandparents, childcare providers, swim instructors and anyone who regularly supervises children around water to learn CPR. You can take CPR classes as well as learn first aid for infants, children and adults through the American Red Cross. You hope you never have to use those skills, but if an emergency occurs, you may be the one to save someone’s life.
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