Baptist HealthTalk

Preventing Child Drownings

June 29, 2021 Baptist Health South Florida, Jonathan Fialkow, M.D., Fernando Mendoza, M.D., Zulma Berrios, M.D., Karina Nania
Baptist HealthTalk
Preventing Child Drownings
Show Notes Transcript

Drowning can happen in an instant, in as little as an inch or two of water. It is the leading cause of injury death in children between one and four years of age, and Florida has the most child drownings each year.  With vigilance and preparation, child drowning tragedies can be prevented. The information in this podcast is essential for every parent, grandparent, babysitter, camp counselor or anyone else responsible for a child's safety. 

Host, Jonathan Fialkow, M.D. and his expert guests outline the necessary steps to keep kids safe around water; from pool barriers and flotation devices to swimming lessons and the critical need for constant supervision and CPR training.

Guests:

  • Fernando Mendoza, M.D., medical director of Baptist Hospital Pediatric Emergency Care

  • Zulma Berrios, M.D., chief medical officer at West Kendall Baptist Hospital

  • Karina Nania, owner of Little Swimmers swimming school

Announcer: 
At Baptist Health, South Florida. It's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life.

Dr. Fialkow:

Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.

Here in South Florida, we’re surrounded by water, from the ocean to lakes to canals to tens-of-thousands of swimming pools. That ever-present attractive nuisance is one reason that Florida has the most child drowning deaths in the United States each year. 

Drowning is the leading cause of injury death in children 1 to 4 years old. It’s a tragedy that can happen in an instant, in as little as an inch or two of water. 

 But we can take steps to prevent child drowning. And we can learn to be prepared in the event of a water emergency. In a recent episode of Baptist Health’s Resource Live program, we discussed strategies to protect children from drowning hazards.

 My guests were:

·      Dr. Fernando Mendoza, medical director of Baptist Hospital Pediatric Emergency Care,

·      Dr. Zulma Berrios, chief medical officer at West Kendall Baptist Hospital, and

·      Karina Nania, the owner of “Little Swimmers” swimming school

 Let’s hear what they had to say….

 Dr. Fialkow:

Fernando, let's start with you. We know that many toddlers are curious, they're active, they explore their surroundings and they seem to be attracted to water. Why are the toddler years considered the highest drowning risk? And why does our statistics bear that out?

 Dr. Mendoza:

Yeah, right. Well you said it, their job as toddlers are to be exploratory. Their job is to go out and explore the world and be kids, be toddlers. So that's really the most important part about water safety and drowning prevention and children in this age is that there is no such thing as turning your head and not being able to supervise. You have to supervise these kids this age 100% of the time, especially around water. It's even more important to do that when you have water features around you, whether it's pool, beach, canal, especially if you're in an unfamiliar situation where you go visit aunty's or grandparents' house or a friend's house that you don't have a pool, but they do. And they may not be kind of child preventative or child protective of the water the way you would normally your house. You be especially careful. The job of a toddler is to explore. You mentioned the nationwide statistics. And, you know, we know that nationwide drowning kills kids between the ages of one to four, more than every other cause except birth defects. Think about it more than car accidents, more than poisonings, it's drowning that kills kids. And in Dade county, we lead the state, with an average of about 45 deaths per year in our county. So it's really a problem here in our county, right at home where toddlers are really the ones suffering the most from this.

 Dr. Fialkow:

Do you have any statistics? And maybe that's true for everyone regarding are drowning deaths and toddlers more likely at the home or outside the home? As you said, when people are visiting the grandparents visiting other places where you might be less attentive or you don't have the proper protection, do you have any sense of that?

 

Dr. Mendoza:

The county doesn't break it down by whether they're at home or not at home, but pool deaths are the leading cause for drowning deaths in the state and in our county. So for sure, it's pools, whether it's at your own house or other people's houses, that's kind of it's hard to parse out. But from experience in the emergency department, we do see, you know, quite a bit of these drownings occur when you're not in your own house but many of them also happen within your own house. Especially when, even though the county requires regulations to have a fence around the yard and even around the pool, I mean, pool fences, aren't 100% effective. They're meant to delay a toddler from getting into the pool. I mean, a pretty smart toddler, three or four year old can get their pool furniture and climb over the fence and get into that pool, especially think about it, they were just in a pool with mom and dad and the family. They were having a great time. There's 100% supervision. Everyone goes back into the house and is doing their thing and the toddler says, ‘I don't want to stop playing, I want to go back into the pool.’ Or maybe we didn't close that pool fence or maybe the furniture was up next to the pool fence, and it taught us, I'm going to go back and explore and do what I thought was really fun. I felt safe and protected with my family. Of course, they're watching me now, the toddler doesn't know that the supervision is not there.

 

Dr. Fialkow:

So the themes that we're going to be reiterating through the course of this Resource Live, are vigilance and don't get complacent. It takes seconds so stay on top of the kid, your child, and be hypervigilant in that setting. And to that end, Zulma, drowning is every parent's worst nightmare. And, unfortunately, you have a personal story. There's this misconception that you'll hear your child cry for help, which gives you the opportunity to prevent a drowning. Is that true? What can a drowning look like just for the interest of making, again, that parent aware?

 

 

 

Dr. Berrios:

So drownings for the most part are a silent event. It's not what you see in the movies and the comedies and commercials that people are splashing and raising their arms and calling attention. For the most part the person that is in trouble and is about to drown they're going to be silent. They're going to try, the only thing that you're going to see is movement on their legs, like if they're climbing a stair. And their eyes get hazy and you see that they fall under the level of the water and they try to move again. 

 

It's not a alarming event for, for the person it's an alarming event, but there's not a lot of noise that will alarm others to be aware of what's happening. 

 

That's why when we do these orientations, we make sure that we touch every point. Supervision, physical measures to prevent and delay, mitigate the access to the bodies of water. Then equip the kids and the toddlers with swimming lessons and the ways to defend themselves. And then in the event that there is a near drowning to talk about CPR. So we take that step wise approach to make sure that when we fail in that split second of supervision that there are other things that are going to protect your children from drowning. 

 

And that's exactly what happened to our family. My niece was during the day at the pool with family, everybody went inside, she was taking nap. She asked for a bottle of milk, dad went to get that and when he went back, she was already under water. She just gained access to the pool again undetected. And there was no warning sign. Unfortunately, she died on about, she would be 16 years now and she was only close to two years old. So those are the things that we want to make sure through this conversations to share, I mean, that is my experience and then that came with the goal. And that's why you said I'm the water safety champion here at Baptist Health and our hospital with West Kendall Baptist because we want to try and equip everyone, all families in Dade County to prevent something like this from happening.

 

Dr. Fialkow:

A lot of times, people think of things that they don't immediately see as remote and can't happen to me. It can happen to us. And again, I thank you for sharing that personal story which obviously drives your passion. And I think anything we can do to really get this message across and resonate with the viewers is of value. So again, I thank you for that as well as being this, our water safety champion. 

 

You create a great segue to Karina, as you said, Zulma we want to look at every opportunity to prevent a drowning from vigilance, surveillance, protection, training, CPR. Let's talk a little bit about water safety and swim lessons Karina. And this is I guess, true for children and parents. And the recent studies do suggest that water survival skills and swim lessons can help reduce drowning risk for all children starting at a very early age. What age do you generally recommend swim lessons? And tell me from your experience and your expertise what can a toddler really learn about water safety?

 

Karina Nania:

Perfect so swimming lessons really offers a layer of protection that anything else really cannot. We accept students as young as eight months. A good way to gauge if your child is ready for swimming lessons would be, if they're mobile, If they're already starting to stand up. They're gripping onto furniture trying to walk around because like Dr. Mendoza said, and like Dr. Barrios said children are extremely curious and the water calls to them. 

 

So we really want to make sure that they get in the water as soon as possible. The earlier you get them in the easier it's going to be for them. And at a young age we're just looking for survival skills. So we want to make sure that they can save themselves in case they fall into the pool and nobody's supervising. Children are curious and sometimes this is a repeated but they're having a great time, everybody goes inside, it's lunchtime, and they want to go back out to keep on having fun. Or they want to climb over the furniture because they want to get back into the pool. So we want to make sure that, God forbid, something happens they can save themselves. Make sure you look for a program that they can turn around, hold their breath, open their eyes. We want to make sure they know where they're swimming to and can get back to safety whether that be the wall or the steps.

 

Dr. Fialkow:

Do you let the parents participate in the training?

 

Karina Nania:

Yes, we do. So we offer several programs. We have a mommy and me program, not just for moms. It can be any caretaker with the babies and that's open for anyone between eight months old to two and a half. But definitely our most popular program is the private, and we do invite the parents to participate as well in the very last day, because we want for the parents to also have the skills to continue building the confidence in their children to know what to do in case they're ever found in this sort of situation.

 

Dr. Fialkow:

That's wonderful. We obviously continue to hear about the tragedy and the drowning, but we don't think of the countless lives that have been saved in a potential drowning environment because the child had had those swim lessons and was able to avoid that. Zulma back to you again, Fernando mentioned barriers like pool fences, one level of protection. Obviously the vigilance is of paramount importance. So what are the kinds of things that we want people to be aware of? They should have in the homes if they have pools or other drowning risks. Or even the make sure that people that are visiting have, if they're taking their family to them. Can you talk about a couple of the things that are available?

 

Dr. Berrios:

Absolutely, as Fernando mentioned, ordinances and codes require that there has to be a gate around the pool or access to the pool that needs to be gated. Important too, it will be a good idea that those should be self-latching gates. So as soon as they close they're latched and will be difficult for toddler to open by themselves. Other things that are are common to find will be nets around the pool, fences, not just the gates. That are iron aluminum gates on the entry points to your backyard. If you have an alarm in your house that has chime that you can activate the chime with the doors open and you can select the doors that go to the backyard and to the access to the pool, to keep those chimes on. So that you know, that if that chime goes off you better run and go and check what's going on. 

In the pool itself there's many different flotation devices and level devices and disturbance of the water detectors that will also ring an alarm. If something falls in the water, not only, you know it could be a cat, it could be your dog, but it could be your toddler that accesses the pool without your acknowledging. 

 

There other devices are personal devices that you can put on your toddler that also when there is a contact with water that will alarm and alarm you, that the toddler is in the water. So there are many different options out there for you to support and make sure that the water access is protected. And that also includes for lakes. If you have a house that has a backyard that faces a lake or a body of water, those should be gated, latching in the same way that you would protect a pool. 

 

Dr. Fialkow:

Karina I'm going to throw a question and a follow up question that you, really to clarify certain things, which as a parent of 20 year olds may not be as attuned to, but certainly one our viewers to be aware of. So, you know, we know that a lot of the drownings occur and the family member, the parent is so close there. So talk about touch supervision, these concepts again, further towards being available and preventing the drowning episode.

 

Karina Nania:

Absolutely. So you want to have a designated water watcher. Especially if you're having some sort of event. You want to have somebody that can reach arm's length and help if they need, if they're struggling, if they need any sort of assistance. Make sure that there's one designated water watcher. Yesterday I read something that says if everybody's watching the pool, that means nobody's watching the pool. Everybody's assuming that someone else is doing the job. And that's when accidents happen. You want to make sure that this person who's watching the water, watching the children in the water, is a responsible adult. Don't leave this responsibility for an older child, maybe an older sibling. It's too much of a risk. Make sure that somebody is watching. If you need to go to the restroom or anything like that want to go inside refill on your drink make sure you pass it along to somebody else. That's also responsible and sober. That's very, very important. You want to make sure that they're watching, counting the children, making sure that the flotation devices, nobody's underneath them. If everybody's wrapping up the event and everybody's going home make sure that you clear the pool, make sure nothing is at the bottom and nothing is there to really draw the children back to continue the party. So you want to make sure that you have someone designated at all times, very, very important.

 

Dr. Fialkow:

Did someone have a comment to add to that?

 

Dr. Mendoza:

I want to comment that, want to add to what Karina was saying is that, if you're going to have an event,   pool parties, birthday parties, we're seeing a lot more of this. You might even want to consider hiring a lifeguard. Someone who's really just their job it is to be on site. And you know, for the same, probably for a lot less money you pay for a bounce house or for a whatever all there, you know, a fun thing you do for the kids especially the young kids. There'll be parents who go to the party who won't want their kid in the pool because of that. But if you have a lifeguard that can give, that's really someone who's actually being paid and trained to keep an eye on that pool.

 

Dr. Fialkow:

I mean, at the time that it takes to answer a phone call on your cell bad things can happen. So I think that's again, a great point. Karina I did mention that maybe you can get into that touch supervision concept a little bit with that, what that actually alludes to. 

 

Karina Nania:

Touch supervision basically is just that you're able to be there. You're watching them constantly. You're looking back, you're able to touch them. It's not just in the pool, bath time as well, you don't want to go. The phone rings, you go, come back, tragedies happen. They can happen in the bath. It can happen, even with the toilet. I remember when my children were young and we had a lock on the toilet seat because we were scared that they were going to get curious. Maybe you want to throw some toys down the toilet or anything just see how it flushed and that they would fall in. Just because of their weight distribution they wouldn't be able to get back out. So you really want to make sure that you're there constantly watching them. It's very simple. It's just, I guess, time consuming and people forget they can do something in a matter of a few seconds, but that's all it takes for a drowning in very little water.

 

Dr. Fialkow:

Fernando now in a tragedy calling 911, usually the first step. What should anyone do if a child is pulled from the water theirs or someone else's if they're there during that episode? What can one do?

 

 

Dr. Mendoza:

Well, for starters you want to make sure that you're safe for the person who's going to be attending to the child. It feels comfortable in or around the water. We'll hear stories of, and I've seen this in the ER, that there's a nanny at the house but they don't know how to swim. So they didn't go into the pool. And then we had to wait until fire rescue gets there. But make sure that you're comfortable in the water. We don't want to turn one potential tragedy into two. 

 

But remove the child from the water as soon as possible who that child is, get them into a safe place, put them on the ground, get them away from the water. And then really you're talking about basic CPR. You know, you're talking about checking for breathing. If you know how to do that, checking for a pulse if you know how to do that. If there's a pulse and you see if you see chest movement and rise and a pulse you wait until 911 gets there. If not, you need to start CPR. And the most important part of that CPR is the compressions not the breathing but the compressions. But certainly before you start CPR calling 911 is of the utmost importance. That's really the most critical thing. 

 

So my advice would be if you have young children for a number of reasons, not just for pool or water safety, for choking hazard, for other things, take a CPR class. There's lots of resources in the community that offer CPR classes for parents, for caregivers, for nannies, for grandparents. And that's really essential. It's just the basics of understanding what it takes to revive and kind of get that bridge until 911 can get there.

 

Dr. Fialkow:

Again, a very important public health message. Hopefully no one will ever need their CPR knowledge and skills, but it does save lives in many scenarios including the ones you just described. So that's another great opportunity people have to both help themselves and family members and maybe some other people in the community. Zulma we talked again, pools aren't the only threats. We have water all around us in South Florida with boaters and water skiers and jet skiers. Let's talk a little bit about life jackets for children and bodies of water. What are the recommendations for life jackets and give us are there any circumstances where it's okay for a child not to have a life jacket in a boat or in a water exposure?

 

Dr. Berrios:

The personal flotation devices or life jackets is they need to be sized to the person that's going to wear them. And the floaties that go on the arms those are not life jackets. And the things are look like a tire that you inflate, those are not life jackets. A personal flotation device is specifically designed to be on your body. And that it will, for the case of toddlers, that will raise the head above the water and keep that head out of the water. But flotation devices are for everyone. You know, we were talking about in the basin we see jet skiers, boaters, rowers people in paddle boards and kayaks. All those should be wearing their life jackets, their personal flotation devices. Because if you go, you know, out, fall in the water there's a lot of upper arm and body strength that you need to get back on your vessel. And I wouldn't trust myself without my personal flotation device when I go out in the water. And then in the boats, the kids should have their flotation device all the time. 

 

I was watching a video out of my hometown of Puerto Rico of a vessel in choppy waters and the kids were jumping. They were jumping on that vessel and almost to the point of being thrown out of overboard if they don't have the flotation device there's not a lot that we can do for them. And it's not only for kids, you know, our teenagers they feel invincible and they will go out very far out on kayaks and on paddleboards without any personal flotation device. That's scary, because again, there's other people in the water at the same time with you a wake puts you off, you have to defend yourself. And if you don't have a flotation device you're going to be depending on your strength that may not be that great. Especially if you're not been on the water and been trained to maintain that stamina, to get back on your vessel.

 

Dr. Fialkow:

Such simple tools like life jackets and flotation devices that can make such a big difference. But they don't work if you're not wearing them when you have that situation. Karina I mean, swimming alone in and of itself is a risk as great an exercise as it is. Can you speak to buddy systems a little bit and what you recommend and preach?

  

Karina Nania:

Absolutely, so we always want to swim with a buddy. It doesn't matter how efficient we are as swimmers. Doesn't matter how well trained we are. We can always cramp up. We can slip, fall, hit our head, fall in. So you want to have a buddy so that if you're in trouble they can go and get help for you or vice versa. 

 

Dr. Fialkow:

Zulma last question as time is quickly upon us. Can you just quickly go through other water hazards that one should be aware of and be vigilant about and inside the house and around the house.

 

Dr. Berrios:

I think that Karina touched upon some of them. You know, buckets, toilets, bathtubs, any of those inflatable pools that you have, that you may use to cool everybody out when it’s so hot outside. . And I want it to make a mention about we need to also make sure that our pools are safe, mechanically safe. That the skimmers are covered that there's no areas that there may be entrapment. And that goes for your personal pools, the people that you're visiting, the community pools in those community areas. And if you're sending your kids to camp make sure that if they're going to participate in camps that will include water events that those are safe and with correct supervision

 

 

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Thanks for listening and stay safe!

 

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