The BMJ Today: Childhood drowning outcomes—prevention is key

My Facebook feed was filled with complaints after the National Football League’s Superbowl broadcast last week. The target? A commercial from an insurer highlighting the importance of preventing childhood accidents. While commenters seemed to acknowledge the importance of the topic, they felt that the message was too dark for an event that is otherwise generally upbeat and fun (at least for fans of the winning team). Given the social media response the commercial did at least succeed in catching viewers’ attention.

A paper from Joke K Kieboom and coauthors and the accompanying editorial in The BMJ this week support the need to bring more attention to prevention of childhood accidents, specifically drowning. This study looked at outcomes of 160 drowned children with cardiac arrest and hypothermia in the Netherlands. They found that a good outcome was more likely if spontaneous circulation was restored within the first 30 minutes of resuscitation, and in the winter season when the temperature of the water is likely to be colder. Outcomes were very poor for children who did not have return of circulation within 30 minutes. In the editorial, Ian Maconochie and Charles D Deakin point out that most drowning events occur away from emergency personnel and thus prevention is the most effective way to reduce mortality.

Access to open water is not unique to the Netherlands. There are over 10 million residential swimming pools in the United States alone. Swimming pools are not the culprit in most childhood drownings worldwide, however. According to a WHO report, 90% of all drownings occur in low and middle income countries where adults and children are exposed to open water through many mechanisms. These include collecting water to drink, travelling on water, working near water, and simply living near open water in ponds, ditches, or other sources.

The good news is that prevention is possible. Installing barriers around open water, supervising children around water, and teaching them to swim are simple steps that could save many lives. Training bystanders in basic rescue and resuscitation may also lead to more positive outcomes. Childhood drowning is a heartbreaking event and it’s always hard to consider stopping resuscitation of a child, even if it leads to poor outcomes as the Kieboom article suggests. With better prevention, these decisions will hopefully become much less frequent.

Rebecca Burch is associate editor for The BMJ.