The Sad Truth About Drowning

Every kid is at risk, even if she can swim. A pediatrician whose young patient died shares the latest precautions.
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Colin Holst was an adventurous, fun-loving little boy who had always been cautious around water. When the 4-year-old completed swimming lessons on June 12, 2008, his confidence soared. His father, Jeff, took a picture of his proud son wearing his swim goggles and beaming. Colin said it was "the best day ever!" The next day, his mom, Jana, took him and his 6-year-old sister to join two other families at a popular community pool.

Colin and the other children played and splashed in the fountains and sprinklers in the shallow end of the pool -- under the supervision of several parents and lifeguards. Before his last trip into the water that day, Colin gave Jana a kiss and went to play under a mushroom waterfall. Then within a few minutes, he was out of sight. It's difficult for his parents to describe the events of that day, but Jana remembers frantically scanning the pool, searching for him. Moments later he was pulled from the shallow water by another swimmer, lifeless. CPR performed at the poolside could not bring him back.

Colin's story touched everyone in his hometown of Austin. But I had a particularly heavy heart because I was Colin's pediatrician. I met Colin on the day he was born and knew his family well. Along with many others whose lives were touched by Colin, I attended his funeral.

Drowning is the leading cause of injury-related death in children 1 to 4 years old and the second- leading cause in kids ages 1 to 15. About 1,000 American children die every year from unintentional drowning. Even more are hospitalized after being pulled from the water and revived. The longer a child is underwater and the longer it takes to start cardiopulmonary resuscitation (CPR), the worse the outcome. It only takes about four to six minutes for irreversible brain damage to occur; 5 to 10 percent of survivors suffer permanent brain damage. It takes just minutes for a child underwater to die.

About half of preschoolers who drown do so in a residential swimming pool. But among babies most deaths occur in smaller amounts of water: bathtubs, buckets, or even toilets.

Perhaps most disturbing of all is the fact that Colin's death wasn't so unusual: Some kids drown in public pools with a certified lifeguard on duty, or under an adult's supervision. Drowning can occur in an instant, and a lifeguard is watching so many people at once that he can miss something that happens so fast. What's more, drowning can be silent. Unlike what we've seen in movies, children do not always flail their arms around and scream for help.

Knowing Colin's remarkable family, I was not surprised that they turned their grief and heartache into an effort to promote water-safety awareness and prevent childhood drowning. They founded Colin's Hope, a nonprofit organization that envisions a world where children do not drown. Jeff Holst says, "Knowledge is power, and in raising awareness we can help save children's lives." In partnership with experts from the YMCA, Colin's Hope provides swim lessons to children in central Texas who need but cannot afford them, and educates thousands more with its grassroots efforts. And it is working: Drowning deaths and drowning- related injuries of children in the target zip codes have been reduced and, in some cases, eliminated.

Colin's parents want you to know that everyone is vulnerable in the water, no matter how well he swims. Take these simple steps to protect your kids.

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Water Safety Tips

1. Be a water guardian.
An adult should actively and visually supervise children who are near or around water. There's no official ratio, but aim to have one adult on water-watching duty for every two or three children in the water. That person can't have any distractions and must keep the children in sight at all times -- even if there is a lifeguard on duty. No talking or texting on cell phones. No reading. No conversations with other adults. No browsing online. No grilling. No alcoholic beverages with little umbrellas in them. Just watching. A water guardian should know how to swim, use rescue equipment such as U.S. Coast Guard?approved portable flotation devices (PFDs) and a reach tool (which looks like a shepherd's rod), have a phone nearby, and ideally know how to administer CPR. Water guardians of kids who cannot swim or swim well need to be in the water, within arm's reach. They should always be able to see kids who are more experienced swimmers. Tell your child that he should never swim without an adult nearby. Explain why it's important to have a "swim buddy" with him to get help if he needs it.

2. Teach your child to swim.
Kids 1 to 4 who take formal swimming lessons can reduce their risk of drowning by as much as 88 percent, research has found. The American Academy of Pediatrics advises that children as young as 12 months old take formal swim lessons if they are physically and emotionally ready to do so. (Note: There's no evidence that these classes are beneficial for infants under 1 year of age.) Unfortunately, though, knowing how to swim isn't enough to prevent drowning, points out Kate Carr, president and CEO of Safe Kids Worldwide.

3. Never leave your child unattended near water.
You hear the phone while you are bathing your baby or toddler? Just let it ring, and advise other caregivers to do the same. Always check the pool or hot tub first if a child is missing. And don't just look at the surface of the water -- check the bottom of the pool, too.

4. Set up four-sided fencing for backyard pools and hot tubs.
Isolate the water area from your house and the rest of the yard. The fence should surround the pool area on all four sides so a child can't get to it (say, through a back door or a window) without an adult's knowledge. The barrier should be at least 4 feet high and climb-resistant, with self-closing and self-latching gates where the latch is placed at least 54 inches above the bottom of the gate. The gate should open away from the pool and should be checked often to ensure that it works. To prevent small kids from squeezing through, the distance between vertical fence posts should be less than 4 inches. You need the same barriers for portable above-ground pools as you do for in-ground pools. Some parents also get sturdy pool covers (not thin solar covers), pool alarms, and door alarms. Always drain the water from an inflatable baby pool after using it.

5. Insist on life jackets.
Make sure your children wear a U.S. Coast Guard-approved PFD when they're on or near water. Kids who cannot swim should use a proper PFD, not "water wings," "noodles," or "inner tubes." These toys are not designed to keep swimmers safe.

6. Install anti-entrapment drain covers.
The Virginia Graeme Baker (VGB) Pool & Spa Safety Act mandates that states install safer drain covers at public pools and hot tubs (spas). The law and the drain covers ("VGB-compliant") are named after a 7-year-old girl who died after becoming trapped by the suction force of a hot-tub drain. If you own a pool or a hot tub, learn about VGB-compliant drain covers at or talk to a qualified pool consultant.

7. Have a phone within reach.
Make sure it's charged, and always call 911 in an emergency.

8. Learn CPR.
In drownings, every second counts. When a child is pulled from the water and isn't breathing, timely CPR can truly be lifesaving. So get certified, then take a refresher course every two years to prevent your skills from getting rusty. The faster a person on the scene begins resuscitation, the better chance a child has of surviving and not suffering serious brain damage

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