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We all have memories of the summer. Sun, fun and often water. I recall one summer when at age 5 our family visited a friend who had a pool. While people were eating and playing my venturous self-went to the shallow end and gradually walked down the slope toward the deeper end as the water kept rising to my mouth. A sense of panic set in as I tried to stay on my tip toes and grab purchase on the rough pool floor in my attempt to scrabble back to the a place where my head would be above water. My older brother happened to walk by and seeing me struggle pulled me to the edge and to safety. Even after shoring up my swimming skills I have always had a healthy respect for the risk of water. Over 3 decades in my practice as a pediatric emergency medicine physician I have witnessed saves and tragedies associated with the water. I have attended to drowning in infants to teenagers and adults. These tragedies have happened in open water, pools and even buckets. It has occurred in organized pools and open water. The COVID-19 pandemic presents a new risk as parents and guardians may be preoccupied by work and other stressors. Deaths from drowning occur quickly and summer is a perfect time to remember how we need to offer multiple layers of protection to keep children and teens safe around water.

In the United States drowning is the single leading cause of death for children ages 1 to 4, and it is a significant cause of death in teenagers. In Maryland in 2017, it was the 3rd leading cause of death among deaths from injury. Social isolation provides opportunities for children to have increased access to a wide variety of water sources including tubs, pools, ponds, drainage ditches where tragedy can occur quickly. If a child or toddler is out of sight for any period as has occurred in a tragedy at a tot lot by a Maryland lake in 2005, always first check the water. Thinking about layers of protection for drowning prevention as recommended by the American Academy of Pediatrics is crucial in keeping children safe during these unprecedented times of social isolation.

According to the AAP, the layers of protection should include:

· All children and adults should learn to swim. If swim lessons are suspended in your area due to coronavirus, it is important to add other layers of protection until your child can access lessons.

· Close, constant, attentive supervision around water is important. Assign an adult ‘water watcher,’ who should not be distracted by work, socializing, or chores.

· Around the house, empty all buckets, bathtubs and wading pools immediately after use. If you have young children, keep the bathroom door closed, and use toilet locks to prevent access.

· Pools should be surrounded by a four-sided fence, with a self-closing and self-latching gate. Research shows pool fencing can reduce drowning risk by 50%. Additional barriers can include door locks, window locks, pool covers and pool alarms.

· Adults and older children should learn CPR.

· Everyone, children and adults, should wear US Coast Guard-approved life jackets whenever they are in open water, or on watercraft.

· Parents and teens should understand how using alcohol and drugs increases the risk of drowning while swimming or boating.

This year, AAP is continuing its water safety campaign with four new public service announcements describing how to protect toddlers and teens around water. The PSAs are available in both English and Spanish. AAP is also making available a series of PSAs featuring the first-person stories of Bode and Morgan Miller, and Nicole Hughes, who lost children to drowning and have partnered with AAP to share their stories to help save other children.

For more AAP resources on drowning prevention, visit


Richard Lichenstein, MD, FAAP

Chair, Maryland State Child fatality Review Team

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