Drowning: Who’s Most at Risk

A recent report from the American Academy of Pediatrics (AAP) re-examines a child’s drowning risk. The report uses new research to examine the factors that put certain populations at increased risk. By learning and understanding these factors, you can help your camp fine-tune its water play rules to create a safer environment for all children.

Know the risks for your camp

According to the AAP, drowning is the leading cause of unintentional injury-related death in U.S. children 1–4 years of age. But statistics tell a more complete story. Age, sex, race, and underlying medical conditions play an important role in drowning rates.

Where should you focus? Policies and procedures that target the following four factors can help improve overall safety in your water play programs. Water play involves swimming or any activity taking place in water.

1. Know the populations at risk. The report states that children at most risk of drowning are in the 0–4 age group. But it’s the second highest risk group that camp operators should pay special attention to: adolescent boys aged 15–19 years. In fact, the AAP claims 75% of childhood drowning victims are boys, and boys older than 1 year of age are at a higher risk of drowning than girls at any age.

2. Setting contributes to risk. The report notes distinctions between drownings in natural bodies of water, in the home, and in swimming pools. One national study highlighted in the report shows that approximately one-half of all drowning deaths in those younger than 20 years of age occurred in natural bodies of water. A high proportion of those in the 15–19 age group drowned in a natural body of water, likely due to hazards like unknown depths and undefined areas. The time of year, temperature, and time of day were significant as well, likely due to unsupervised access to the water. Drownings increased between May and August, in air temperatures of 86 F and above, and in late afternoon times of 4–6 p.m., according to one report cited by the AAP.

3. Understand racial and sociodemographic disparities. The report indicates that drowning rates for Black children were significantly higher than those for white and Hispanic children at every age from 5 years to 18 years. American Indian and Alaska Native individuals have the lowest drowning risk of all races and ethnicities in swimming pools but the highest in natural water settings. Underlying reasons for the disparities are not well known, but may include cultural norms, historical lack of access, economics, and environmental influences. Understanding a group’s historical relationship with water play may help inform your safety procedures.

4. Factor in peer pressure. The AAP claims that one reason older adolescents have the second-highest drowning fatality rate is attributed to their peers. According to the report, the mere presence of peers promotes risk-taking activity. The report lists other factors for adolescents as overestimation of skills, underestimation of dangerous situations, engagement in high-risk and impulsive behaviors, and substance use.

What you can do—Multiple layers of protection

You likely have a robust swim safety program already in place. But now that you know increased risk factors often play a role in drownings, could your camp practices and procedures use a second look? Be sure to consult local and state laws and a licensed attorney before making changes.

A single protection measure is not adequate—the AAP report states that multiple layers of safety measures are necessary to help prevent drowning and keep children out of harm’s way. Here are a few from the report:

Achieve water competency. Water competency—which includes safety knowledge, attitudes, response to a swimmer in trouble, and basic swim skills—may be the most important drowning prevention measure. This can be especially true if your camp features a natural water area that is hard to close off during non-supervised times. The American Red Cross defines water competency skills and details more about how the skills contribute to the overall layers of protection.

Practice the three components of supervision. Supervisory behavior is composed of three components:

• Proximity. How close are your supervisors—camp counselors, staff, and lifeguards—to those engaged in swim play? Are they within arm’s reach of non-swimmers?

• Attention. Are your supervisors distracted with other duties while watching children? Do you have a proper supervisor-to-swimmer ratio (check with local laws; ratios may vary depending on the children’s ages and activity)? Do you prohibit supervisors from using phones or engaging in any distractions?

• Continuity. Are supervisors aware of and enforcing the rules? Do you consistently train every season, even for returning supervisors?

Lifeguards are your first line of offense. Lifeguards are usually worth every penny. In addition to their life-saving training, they perform important prevention activities that make water play safer by enforcing rules and educating swimmers. Simply put, lifeguards help reduce situations likely to end in injury or drowning.

Identify those with medical conditions. Supervisors should be made aware of children with underlying medical conditions, like autism, ADHD, epilepsy, and neuromuscular diseases. These children are at a greater risk of drowning and need even closer supervision.

Install physical barriers. Entrapment and hair entanglement remain a risk for children. Ensure that you have all legally required protective measures for items related to circulation systems, drains, and pipes that prevent hair and body limbs from becoming trapped. In natural bodies of water, rope off areas that correspond to water competency levels. When supervision is not possible, prevent access to water.

Train for the “Drowning Chain of Survival.” It’s possible to interrupt a drowning at any one of 5 stages. The Drowning Chain of Survival is a series of steps that, when enacted, work chronologically to prevent drowning. The steps are as follows: be safe in and around water, learn to recognize distress, prevent submersion with a flotation device, remove victim from the water, and provide care as needed.

More resources from Brotherhood Mutual

• Water Safety Checklist

• Swimming Pool Safety Checklist

• Creating a Swim Wristband Program

Posted August 19, 2021

The information provided in this article is intended to be helpful, but it does not constitute legal advice and is not a substitute for the advice from a licensed attorney in your area. We strongly encourage you to regularly consult with a local attorney as part of your risk management program.