I'm going to let you in on one of the most important lessons I learned early on, in my years of training to become a doctor: Absolutely anyone can drown, or lose a loved one to a drowning.

The Centers for Disease Control and Prevention estimates that more than 3,900 people die from unintentional drowning in the US each year — with one in five under 14-years-old. And for each pediatric fatality, another five children require emergency care for nonfatal drownings that can cause irreversible organ damage.

Every patient or family I've cared for after a drowning accident has said they didn't think it could happen to them. And yet, it happens, along with the cruel "if onlys" that haunt cautious and well-intentioned people in the aftermath: "If only I'd done something different, or known what to look for." I hear this again and again, especially from those who've lost a child.

Unfortunately, research shows that in the majority of drowning cases, the child was being supervised by an adult when the accident happened. So, as our summer of post-vaccination reunions and vacations heats up, remember just how vulnerable kids are in water. The rate of admissions for nonfatal drownings at the Arnold Palmer Children's Hospital in Orlando, for example, was already double in May what it was in the last three years at that same time.

Among basic water supervision precautions, a few potentially life-saving details are often overlooked. Here are some essentials to help keep our young swimmers safe this summer:

Follow the 'arm's length' rule

It may sound commonsensical to stay close by when kids are in or near a pool or other body of water, but it's important to know what safety experts consider close enough supervision to avoid a drowning event.

The American Academy of Pediatrics recommends that adults who are supervising a child of any age who isn't a strong swimmer should be within one arm's length at all times when kids are in the water, offering "touch supervision" this way.

Dr. Andrew Schmidt, a lifeguard-turned-ER doctor at University of Florida Health-Jacksonville and an expert in water safety, notes the definition of a "strong swimmer" is subjective — and overestimating a child's independence in the water has led to tragic accidents.

Schmidt falls back on the way the American Red Cross, a longtime leader in teaching water safety, defines a "water competent" swimmer. According to the Red Cross guidelines , someone is water-competent if they find themselves in water over their head and are able to:

  • Swim to the surface after being submerged, then float or tread water for at least one minute.
  • Swim in a full circle and find an exit, then swim about 25 yards to that exit.
  • Get out of the water on their own, which means exiting the water without a ladder if they're in a pool.

That's a good starting point for judging kids' vulnerability in the water, but adults still need to stay vigilant. "Even a strong swimmer can get into trouble," warns Dr. Terri McFadden, a professor in the department of pediatrics at Emory University's School of Medicine and medical director of the Injury Free Coalition for Kids in Atlanta.

Treat water safety supervision like a job

Calling appropriate water supervision an "intense job," McFadden is quick to remind the parents of her patients to stay alert even if the child is a proficient swimmer.

Having older kids or young teens — or adults that are weak swimmers — acting as chaperones isn't safe, she says. And if you're the adult in charge, doing anything that draws your eyes away from the water for just a moment is risky. Reading, using your phone in any capacity, socializing, fiddling with the bluetooth speaker or doing household chores – all such lapses are dangerous when children are swimming or playing in water. Drowning accidents have happened in the time it takes for a caretaker to run inside just long enough to put wet clothes in the dryer, or while they were looking on from a kitchen window and doing dishes. No distraction is quick enough to be safe when it comes to kids in or around water – not seconds, not minutes.

Mcfadden is among many leaders in child safety who recommend assigning an adult "watcher" at the pool or waterfront who can agree to be totally attentive for a brief period of time (15 to 30 minutes or so), then switching to another watcher in intervals; short spurts of duty making it easier to stay focused. It doesn't matter at a pool party that there are a dozen responsible adults nearby; if there isn't one pair of mature eyes devoted to watching the young swimmers 100% of the time, the risk of a deadly accident goes up.

Similarly, it's never safe to simply rely on lifeguards. Though trained to scan for emergencies and quickly respond, they can also get distracted, especially when there are lots of people bobbing along or jumping in and out of the water.

Stay sober when you're the adult in charge

There's also been a well-documented spike in alcohol use during the pandemic, and coupling that increase with an uptick in warm weather and waterside celebrations with friends and family can be a drowning accident waiting to happen.

Not only does alcohol lower our level of alertness and slow the reflexes needed to act quickly when we spot danger, it will also make swimming and helping someone to safety slower and more difficult as well.

And I'm not just talking about avoiding being drunk; cognitive processes and reflexes can slow after just a drink or two. Should something bad happen, it's not worth the heartbreak of wondering if the outcome could have been different without alcohol — something I've witnessed first-hand among some families of drowning victims.

The safest bet is to designate one fully sober adult as the watcher for 15 to 30 minutes at a time when kids are in or near the water. "Sober" means those adults agree to not use any mind-altering substances in that time — not alcohol, marijuana or even some allergy medicines or other prescription drugs that can cause drowsiness.

Use the safest life jacket, but don't rely on it alone

Life jackets do provide an added layer of protection against drowning, and most states require kids to wear them at all times when on a boat — regardless of their swimming strength.

Water safety and drowning experts recommend kids only wear life vests or jackets that are US Coast Guard-approved, which includes many different brands and will be noted clearly on the tag or printed onto the life jacket itself, along with a number that tells you what federal regulation it's approved under.

Pay close attention to what's printed there; the labels will tell you if it's not meant for weak or non-swimmers. You'll also find the weight range the vest is designed to fit. It should be nice and snug; wearing a loose life vest is like not wearing one at all.

Schmidt also cautions parents against relying on any unregulated flotation devices — including arm floaties, swimsuits with built-in floats or blow up neck rings. They may be cute, but can provide a false sense of safety that supports distracted supervision, he says.

Don't let shallow water deceive you

The risk to kids isn't equal to the depth of the water when we're talking about drowning. Small children can drown in baby pools, bathtubs or even household water buckets or tide pools — anything with enough water in it to cover their mouth and nose if they can't lift themselves out easily. They need adult supervision in these places, too.

And be forewarned — though child gates, locks and other safety measures are additional safety layers, if you've ever seen a kid use an iPhone you know that they're smart, and craftier than we realize. Most can still problem-solve their way around those barriers and into the water no matter the physical precautions.

Be ready to recognize what drowning or distress looks like

Parents and caretakers are often surprised to hear that drowning can look like nothing you'd notice, hear, or even expect — which is why it takes 100% visual and/or touch supervision to pick up the signs. The splashing, yelling and commotion you've seen in movies could certainly be a signal a child is in trouble, but it doesn't always happen that way.

Instead, be on the lookout for subtle and quick: a child motionless or face down in water or swimming upright but not making any progress forward; a lowered head, or a head tilted way back or with hair covering the eyes or face; a look of fear or doom in a child's eyes; or perhaps just a constant gaze toward shore or an exit/ladder. And a child that jumps or dives into the water but doesn't come up quickly could be missed without sharp visual supervision.

A swimmer of any skill level might need your help, and it can often take all of our senses on full-alert to identify a drowning in progress.

Swim classes are available for even very young kids. Enroll your child ASAP

Many 1-year-old babies can benefit from swim classes taught by a skilled instructor, according to the AAP. Children develop along different timelines, so check with your doctor to see if your child's ready to start.

And swim classes aren't just for beginners or kids — people of any age or ability can benefit. Even if you already know the fundamentals, swim instruction will help you expand your skills and be even safer in the water. Many instructors nowadays teach safety tactics like safer ways to jump into the water, how to safely escape an ocean's riptide or undertow, and how to save others from drowning without putting yourself in danger.

You can find classes through community pools, health departments or regional chapters of the American Red Cross or YMCA; some local nonprofits offer scholarships, so cost shouldn't be a barrier. Plus, the same groups can help you find CPR classes, which is a must for all chaperones and other adults — whether or not water is involved.

It's impossible to fully control environments where water and kids mix, but what we know about drowning is this: Sharp-eyed, adult supervision is key to prevention. And parents can't do it alone — if we all share the responsibility whenever we're near the water, we can save lives.

Dr. Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

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