Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence

Abstract

Introduction: Evidence from Ireland’s Childhood Mortality Register demonstrates that drowning is the second leading cause of death in children. It occurs more commonly in adolescent males engaged in summer water-based activities and in children aged 1-4 years with access to swimming pools/unprotected water sources. Despite being an island nation, a significant lack of guidelines exists to reduce drowning accidents in these at-risk populations.Aim: Review international evidence surrounding risk factors associated with drowning accidents in the paediatric population and existing risk-reduction guidelines. Methods: Structured review of Cochrane, Cinahl, Pubmed Web of Science databases performed using search terms: (“risk factors” AND “drowning”), (“risk reduction” OR “prevention” OR “swim ability” AND “drowning”). Studies were included if satisfied age criteria (0-18 years).Results: Evidence suggests that boys are at highest risk of drowning (1-4 yrs in swimming pools; adolescents in freshwater) with inadequate surveillance, inadequate availability of first responders, certain clinical diagnoses (developmental delay and seizure disorders), lack of swimming ability, and substance misuse in adolescents all posing an increased risk. Formal swimming education in those aged 4+ years, training of supervising adults in safe rescue, installation of isolation barriers, enforcing water safety guidelines, and regulations are all recommended by International Advisory Groups for prevention of drowning.Conclusion: In Ireland, drowning is the second leading cause of accidental paediatric death in the post-neonatal period, and an important cause of childhood fatalities globally. Risk factors increasing the likelihood of fatal paediatric drownings include gender and distinct age peaks. Certain modifiable risk factors relate to peri-event factors such as lack of supervision, to post-event responses, in particular including lack of trained personnel at the scene. There is a poverty of guidelines specifically targeting the paediatric populations; guidelines generally tend to be included into adult drowning reduction strategies. Specific targeting is required to protect those most at risk.

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019)

“…In this study children were in the high-risk group, and the highest frequency referred to two-year-old children. Almost similar results were found in a study held in Ireland by Davey et al showed that the majority of drowning cases affected children between the ages of 1-4 ( 8 ), other studies held by Evans et al ( 9 ), Denny et al ( 10 ), Wang et al ( 11 ), and Raess et al ( 12 ) showed that drowning mostly affected children under the age of 5 which comes in agreement with our findings. This result may have been caused by the absence of children strict supervision.…”

“…This result is caused mainly because of swimming activities held during summer time with the lack of swimming ability among certain age groups. Several studies conducted in Ireland, France, Australia and china by Davey et al ( 8 ), Bessereau et al ( 18 ), Leavy et al ( 19 ) and Liu et al ( 20 ) respectively, together with a study held by Loux et al ( 21 ) revealed that summer was the season with the highest percentage in regards to risk factors associated with fatal drownings compared to other months of the year which came out with agreement with the results of this study.…”

The epidemiology of drowning among Saudi children: results from a large trauma center

“…The AAP strongly advises that parents practice “touch supervision” for young children, where they can be immediately reached at all times around or in bodies of water, baths, or swimming pools. 20 , 21 Adult supervision is especially essential in the vicinity of pools, particularly those with no installed security measures. We found that most severe drowning events (18 out of 22) that were complicated with neurological outcomes or death occurred in private pools.…”

Individual, environmental and demographic factors may play a role in the prognosis of fatal and non‐fatal paediatric drowning

“…To date, there have been limited European studies on drowning, and only one has reported a Mediterranean case series with environmental characteristics similar to ours. 3,7,13 In these studies, the authors have reported more adverse outcomes, including a higher need for CPR and deaths. However, this can be partly explained by a larger number of tourists rather than resident children in their samples.…”