Prevention of Drowning – PediaCast 520

Show Notes


  • Dr Sarah Denny and Dr Jeffrey Brown visit the studio as we consider the prevention of drowning. We explore pool safety, swimming lessons, and water rescue… important topics because drowning is common and occurs without warning. We hope you can join us!


  • Prevention of Drowning
  • Pool Safety
  • Swimming Lessons
  • Water Rescue




Announcer 1: This is PediaCast.




Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.


Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.


It's Episode 520 for June 23rd, 2022. We're calling this one "Prevention of Drowning". I want to welcome all of you to the program.




So we have a really important summer safety topic for you this week as we consider the prevention of drowning. And it's important because drowning is a leading cause of injury-related death in young children. And every year, during warm weather months especially, we hear stories of personal and family tragedy. And the situations of these stories are almost always preventable by paying attention to some fairly simple rules and safety measures.


We're going to cover lots of ground today regarding pool and water safety, as we consider the prevention of drowning. We're going to explore rules and safety measures for home pools, public pools, and swimming pools at day camps, and overnight camps. We'll consider swimming lessons and water safety courses, pool drains and other equipment considerations. And we'll share ideas for introducing accountability into your friend group, and into your families, your communities, as we attempt to keep kids safe and prevent the tragedy that is drowning.


To help us with the topic, we have a couple of excellent guests joining us. Dr. Sarah Denny is a primary care pediatrician and a water safety and drowning prevention expert at Nationwide Children's Hospital.




Dr. Jeffrey Brown is a clinical psychologist at Harvard Medical School. He's going to be here to share a personal perspective on the impact of drowning on families and communities when tragedy strikes close to home.


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So, let's take a quick break. We'll get Dr. Sarah Denny and Dr. Jeffrey Brown connected to the studio and then we will be back to talk about the prevention of drowning. That's coming up right after this.






Dr. Mike Patrick: Dr. Sarah Denny is a primary care pediatrician at Nationwide Children's Hospital and an associate professor of Pediatrics at the Ohio State University College of Medicine. She has a passion for keeping kids safe from dangers such as drowning. And she advocates for pool and water safety at the state and national levels.


She's a former member of the executive committee of the Council on Injury, Violence, and Poison Prevention for the American Academy of Pediatrics and is the lead author of the 2019 Policy Statement from the AAP called Prevention of Drowning. She also serves as co-director of Resident Advocacy Education at Nationwide Children's Hospital and enjoys teaching new pediatricians how to effectively advocate for patients and families.


Dr. Jeffrey Brown is a clinical psychologist affiliated with Harvard Medical School. He has a personal interest in pool safety and drowning prevention. And he's here to share how this topic has impacted his family and how we all can raise awareness about the problem of drowning and what communities and families can do to keep our kids safe in the water.




So, let's give a warm PediaCast welcome to Dr. Sarah Denny and Dr. Jeffrey Brown. Thank you both so much for being here today. Yeah, I really appreciate both of you at taking time to chat with us.


Sarah, I wanted to start with you. What do we mean when we use the word drowning?


Dr. Sarah Denny: Sure, yeah. So, drowning is really described as a process, first of all. That's really important to remember that it is a continuum where the person who goes under the water experiences respiratory impairments, so difficulty breathing from submersion or immersion in a liquid.


And it can vary depending on how long the person has been submerged to really know bad outcomes to all the way to death. And so at any point within that process, we can intervene and try to minimize the amount of injury or potential for that.




Dr. Mike Patrick: I just want to mention some other terms that are not necessarily good terms, but ones that you sometimes hear out there. And so I just want folks to understand what they mean.


One is near-drowning. And so that's going to be more like a close call in the water. So it doesn't result in death but…


Dr. Sarah Denny: Yeah. I'm so glad you brought that up because there's a whole host in terms of people use in the media or just amongst people talking that are incorrect. So there is really no such thing as a near-drowning, like you either drown or you didn't. But then the outcome is that continuum.


Other words that really in a drowning community or in a drowning research body that we do not use are wet drowning, dry drowning, secondary drowning, active drowning, passive drowning, silent drowning. It's drowning, right? Like you have this event or you do not have the event.




Dr. Mike Patrick: I think that's really an important thing. So when you hear media talk about secondary drowning, sometimes they raise alarm and like, "Oh, they could happen a day later and there were no symptoms in between." And really that's not the case. Most of these kids who do have a delayed response did have some symptoms and then things escalated to the point where parents are like, "Oh, this is an issue." So we don't really have to worry about sort of severe symptoms developing out of nothing.


Dr. Sarah Denny: Absolutely correct.


Dr. Mike Patrick: So then how common is drowning?


Dr. Sarah Denny: Well, unfortunately, Mike, it is very common. In fact, it's the leading cause of injury, death in the one to four age group.  And so, despite our prevention efforts, it still continues to be an issue which is why I'm so glad you're talking about this topic.




We actually see another peak in adolescents for totally different reasons, right? So our one to four-year-olds are curious. They're very impulsive. They're fast and they have no sense of danger. Whereas, our adolescents tend to have an overestimation of their skills, higher risk-taking activity, and sometimes there may be substances involved.


So they drown in different areas. Our one- to four-year-olds tend to drown in a pool, whereas our adolescents are more likely to drown in open water like a lake, a pond, or quarry, that type of setting.


And then we have our toddlers or less than one-year-olds or kind of 1 to 18 months who are most likely to drown in the home. And that's things like the bathtub, a bucket of water, even a toilet. So anywhere there could be water in the home is a potential risk for our youngest kids.


Dr. Mike Patrick: And it doesn't take a lot of water, right, especially for these young kids. I mean, you can just have a baby pool with an inch of water and it could be a problem if they fall down face first.




Dr. Sarah Denny: Correct. That's why we really encourage families not to leave any kind of standing water. You can get latches for your toilets. If you have one of those little waiting pools, make sure you're emptying it, if you're not right there with your child. Because you don't want your child or someone else's child to gain access to that water, a neighbor who wanders into the yard, that type of thing.


Dr. Mike Patrick: Yeah, absolutely. So what should parents do to supervise their kids around water? What are the top things that parents can do to really keep their kids safe?


Dr. Sarah Denny: That's a great question because it is all about prevention. And what's really important to know about drowning prevention is there's not one single thing. It's layers of protection that we encourage to really keep our kids safe. So first is adult supervision.


Actually, let me back up. Really, what I should say is, we really think of drowning prevention in two different scenarios. The first one is when a child's expected to be in and around water. And I'll go through those prevention strategies in a second.




And then the other one is when a child is not expected to be in and around water. So, that's maybe you have a pool at your house and you weren't swimming that day or that evening. And you're cooking dinner and your child unexpectedly gains access to the pool. So there is that scenario, where four-sided fencing is your number one most effective drowning prevention strategy.


Now, when kids are expected to be in and around water, we have those many layers of protections such as adult supervision. And that means constant capable adult supervision. Not being distracted, not being under the influence of anything, but really watching your children.


If you have beginner swimmers, a parent or an adult, I should say, should be within arm's reach of that beginning swimmer. Lifeguards, so if you're swimming whether it's out of pool or at an open water site, making sure your lifeguard is there. However, the presence of a lifeguard doesn't mean that the adult shouldn't supervise their own children. That's, again, another layer. So, you have the parent watching, and you have a lifeguard watching.




Swim lessons are another one. So the American Academy of Pediatrics recommends that the child is developmentally ready, they can start swim lessons by one year of age. It's not a one-and-done type deal. That's a continuous process. So as the child grows and develops, they should continue to stay in swim lessons.


And I tell my families, swimming is a life skill. It's as an important as tying your shoes, learning how to cross the street, any other number of things that we teach our children how to do to keep them safe. They don't have to have perfect strokes. They don't have to be in a swim team. But they have to know the basics. We call it water competency. So that if they were to fall into the water over their head, they could get themselves up to the surface and then over to safety.


Another is CPR. We talked a little bit about that continuum at the beginning of the podcast. And so, we know that early bystander CPR is incredibly effective in preventing long-term consequences of drowning.




There's many different layers, having access to an EMS is one. So having a phone that you can call if you need help is really important.


A life jacket would be another one. You know your child is going to be in and around water. Maybe you're going boating. Everyone including the adult should have a life jacket on because we know that kids are much more like to wear life jacket if their adult is modeling that kind of behavior.


Dr. Mike Patrick: Yeah, absolutely. You mentioned constant supervision and also lifeguards. What about if you're at a public pool and there are lifeguards there? Still a good idea to keep constant attention on your children?


Dr. Sarah Denny: Yes, definitely. Because the lifeguards are watching many many children. Many swimmers, I should say, not just children because there are adults who don't know how to swim as well.




So, if you have a beginning swimmer, then I would say absolutely. I mean, I personally have had to jump in after my own kids. Not because the lifeguard did anything wrong but I was really dialed in on my swimmer when I realized he was struggling.


That's just a good point to say that kids drowning doesn't look like what you see in the movies. And so, it's not always necessarily easy to recognize. And so, when you're watching your child and you know their swimming abilities and you start seeing like something is not right, then that is a great layer of protection to be able to intervene in case the lifeguard doesn't notice that.


Dr. Mike Patrick: A lot of times, families go to the pool together, or in the neighborhood, you all go to the neighborhood pool together. So there could be the opportunity where if you are socializing that you sort of take turns, keeping an eye on your group of kids. So that's a possibility.


The safest thing that everyone looking one-on-one on their own kids but parents also want to talk together and socialize. And so, sort of taking turns, maybe a good thing.




And then, also, phones are so distracting. You may think that you're keeping an eye on your kids but as you look down at your emails or your social media sites, your eyes are always on there longer than you think they're going to be. And so…


Dr. Sarah Denny: That's a great point. And so, the instance where you're talking about where there's a group of people, it's a really great idea to have an assigned water watcher, who their job for X amount of time whether you guys do 15-minute shifts  or whatever the group decides, their designated task is to watch the children. Not be on a phone, reading a book, chitchatting with other people because when everyone's watching, no one is really watching, right?


So making that a designated role and then rotating it, so like that one person isn't isolated the entire event, is a really great concept and something to think about.




Dr. Mike Patrick: And the other thing I wanted to mention is if you have a private pool at your home and you're having a pool party with other kids there, it may be a good idea to hire a lifeguard. I mean, there may be someone in your neighborhood who that's their summer job and they want to make a little extra money.


And actually, we did that when my daughter had her five-year birthday party. We knew there were going to be other kids at our house and we had a pool at that time. And we hired a lifeguard.


And sure enough, my son, who is three at that time, who always was very careful around the water, wear life jackets, and he saw the other kids in the water and made a beeline for the pool, went straight in down to the bottom. The lifeguard had just gotten there, still have his sweatpants on over his swimsuit and he jump in and rescued my son. So, we gave him a tip. He got a little more than what we had agreed.




Dr. Sarah Denny: I'm so glad that he was there…


Dr. Jeffrey Brown: Was there, absolutely.


Dr. Sarah Denny: To save your son so quickly.




Dr. Mike Patrick: And then, I wanted to ask about swimming lessons. So, of course, swimming lessons are going to help kids feel more comfortable being able to get themselves up to the surface if they go under and feel a little more confident with swimming. At what age can folks start swimming lessons and how comfortable should parents be that their kids are progressing well in swimming lessons in terms of that supervision part?


Dr. Sarah Denny: It really depends on the kid. And so, I would definitely say once a child turns one, it's time to at least start thinking about swim lessons. Maybe have a talk with your pediatrician.


Do you think that your child's listening and receptive skills and motor skills are at a point where swim lessons would be beneficial? For some kids, it might be one. For some kids, it might be two. It really is going to depend on the child on their own needs but there are studies that show that starting swim lessons at one can help prevent drowning.


And as far as at what point can a family or caregiver start feeling like their child is progressing, it's really important with swim lessons that you're in some sort of program where there is communication both ways. Where the instructor is giving you realistic feedback on how your child is doing.




 We don't want someone to put their child in swim lessons, think that they're fine and they can swim, when in fact, they cannot. I mean, it is a continuum, right, of learning how to swim and learning safety behaviors. And so that is taught over time in swim lessons. And so we want to make sure that parents don't just think, "Oh, they've done swimming lesson. We're good to go." Because that is not the case.


And even in strong swimmers, they should never swim alone, always swim a buddy. We go on summer vacation to a lake and my kids know, even though they're all in a swim team and they're all strong swimmers, they are not to get in the water, even their toe in the water, without an adult down there to watch.




Dr. Mike Patrick: Yeah, really good points. Swim lessons are also typically done in pools which is very different than open water. And so, it's going to be important to stress to our kids and especially our teenagers that just because you can swim well in a pool doesn't mean that you're going to swim well where there might be waves or strong currents, even uneven surfaces that can make swimming more difficult, right?


Dr. Jeffrey Brown: Correct.


Dr. Sarah Denny: That's absolutely right. Those skills don't necessarily translate water temperature. The current is such a big one. I mean, that's scary. Even in a strong swimmer, when you feel that current, that undertow, it can be scary. So knowing what to do if you do get caught in that current, how do you manage that, is potentially a lifesaving skill.


Dr. Mike Patrick: Yeah, absolutely. I'm going to put a link in the show notes to resource from the American Red Cross as we're talking about swimming lessons called Longfellow's WHALE Tales Resources. And these are supplements to swimming lessons. So they're not in the water. These are online water safety programs that really used a lot of fun things, cartoons and videos, and articles, and lots of resources. And you can even print out a certificate of completion once your child's gone through.




So just an added layer of water safety that folks can use from the American Red Cross and I'll put a link to that in the show notes so folks can find it easily.


As we think about of the rules that we want to communicate with our kids around pools and other bodies of water, you had mentioned some, one, is you don't get in the water unless there's adult supervision. You make sure that you're swimming with a buddy. What other rules just around the pool in general should we be enforcing?


Dr. Sarah Denny: So, talking to your children about where is it safe to dive, where is it not safe to dive? Making sure you're pointing out where it's deep and over their heads. So that if they decide they're going to swim across the pool and maybe they don't have that kind of stamina, they recognize that, "Okay, I can't do that over there but I can do it over here."


Talking about safety regarding if they're going to go up the diving board, down the slide, all those types of things are really important.




Dr. Mike Patrick: Yeah, absolutely. And then rules around the pool itself, no horseplay, don't run around on the deck. We see a lot of kids, that can get slippery, and so you run and trip and slip and then you have a head injury. So you want to be careful.


And then the drains that you want to make sure there's a proper drain cover at the bottom of the pool and just stay away from the drain, right?


Dr. Sarah Denny: That is a great point. So whether it's in a hot tub, in a swimming pool, yeah, stay away from the drains. As an adult, we see something that doesn't quite right with the drain, maybe their screw is missing or it looks like it's broken in some way, let somebody know right away so they can address that issue.


Dr. Mike Patrick: Yeah, absolutely. And then a lot of parents wonder about eating and then swimming, like "Oh, you have to wait for x number of minutes after you eat before you can swim." Is there any truth to that?




Dr. Sarah Denny: No.




Dr. Sarah Denny: It is good to get your kids out of the water and give them a rest and reapply that sunscreen and that kind of thing. So that's why we have rest periods at the pool. But if you're at the beach or you're on your own pool, maybe you don't have these kinds of things built in the way you would at a public pool. So it is a good idea to take a few minutes, let's rest, let's check in, let's make sure we're hydrating.


Those kind of things are really important but, yeah, we don't need to sit kids out for a certain period of time. I would say not swimming while eating and drinking, not running around the pool eating and drinking just from a choking standpoint makes sense.


Dr. Mike Patrick: Yeah, absolutely. I'm sure that came about from a parent once upon a time like, "I just need a break. I don't want to watch my kid in the water anymore. So after you have your peanut butter jelly sandwich, you need to…"


Dr. Sarah Denny: Just sit.


Dr. Mike Patrick: Sit out for half an hour."




Dr. Mike Patrick: And then, one other thing I wanted to mention was hot tubs. A lot of folks have those at homes and they also can be at some hotels, oftentimes, they'll have a hot tub. Especially little kids, we want to keep them out of the hot tub and just realize that you can drown on a hot tub, too.




Dr. Sarah Denny: Yes, and that kind of goes back too, well, so, yes, you can run in a hot tub. Also gets very hot and is dehydrating. And so that can be an issue. We worry about the drains in a hot tub.


But also going back to the instance where our kids are not expected to be in and around water, things like pools and hot tubs can be a huge risk if your child's unexpectedly gaining access to that water. And so, four-sided fencing I mentioned with the self-closing, self-latching gates, so that they cannot get in.


The house is not considered one of those four sides, right, because if a child is able to slip out a door and gain access to the pool, then that's not secure. So four-sided fencing is the most evident space. There is some current research going on, on things like door alarms, the water surface alarms. So those would be potential other layers to add on to that four-sided fencing but those in and of themselves have not yet been proven to be effective in preventing drowning.




Dr. Mike Patrick: Yeah. So ideally, you have four-sided fence. For some folks, that may not be a possibility depending on how their house is designed. Especially as I think about folks that live in a warmer climate and have the lanais with the screen and thing around their pool, it may be hard to put a fence there. So even though there's no evidence, I would think that a door alarm might give you a little bit more comfort than not having an alarm at all.


Dr. Sarah Denny: Yeah, a door alarm. One of those alarms that alarms when the surface of the water is broken. And doing things like get the toys out of the pool so that there's not that temptation if the child is like, "Oh, look! My pelicans floaty thing is in the pool" to get in after it. And so clearing the pool of those kind of items that might serve as a temptation is just one more layer.


Dr. Mike Patrick: Yeah, child-proof locks on doors that go the outside would be helpful as well. What about rescue and first aid equipment for home pools? Should folks have things available to help rescue people?




Dr. Sarah Denny: Yeah, so first I would say CPR is the single most effective kind of first aid skill that anyone could have, whether it's the pool, whether it's at the lake, at the pond, whatever. That is such a critical intervention. And if you have a pool, you really should learn how to do CPR.


So, if there is an instance where someone is in trouble, obviously, you need to make sure that it's safe for you to get in, too. Or if you can reach something to get the person who's struggling and have them grab onto it, so you throw a buoy that's attached to a rope. Or you have pole, something that they can grab on to. A shepherd's staff would be another tool that you could use.


Those are all really important to prevent that submersion entry. But once a child or any person has gone under, if they're unconscious, then activating your EMS system, calling 911 and starting CPR is really critically important.




Dr. Mike Patrick: And you can find CPR classes again with the American Red Cross in your area to do those. And then, I would think just maintaining any equipment that you have around the pool, ladders, handrails, diving board, just checking them periodically to make sure that nothing's come loose and that everything is functional is going to be important. And then those pool chemicals, we want to keep those out of the reach and sight of especially young kids as well because that can be another potential danger around home pools.


So we kind of mentioned this but I think it's really important to really iterate it. If there is an emergency, you witness a water emergency, it's probably a good idea to go through in your mind what you're going to do. So that if it does happen, you at least thought through this before.


So kind of walk us through, you have a kid who has slipped under, they haven't popped up. It's seems like it's been too long. What do you do?




Dr. Sarah Denny: So yeah, actually I would even take a step back. If you can't find your kid, I mean, kids are off playing in the closet or they're off whatever, and so you lose sight of them. I mean, that's just part of being a parent, right?


But if you notice that you haven't heard or seen your kid in a minute and you're looking for them and can't find them, first place to check is the water, right? Because we know every minute counts. So, check the water first.


If they are submerged and it's safe for you to get in and get them, meaning there's not like electrical something in the pool, and obviously, you know how to swim yourself. We don't want someone who doesn't know how to swim also drowning. Then, it would be get that person out of the water and start CPR immediately. Hopefully, there is someone you can yell to for them to be calling 911 at the same time, but really, starting that CPR as soon as possible is really important.




Dr. Mike Patrick: And if it's a diving injury, if we're worried about the head and neck at all, you want to try to keep that still while you're waiting for EMS to arrive.


Dr. Sarah Denny: Yeah, that is a really challenging situation because we know CPR is so important, but if we're worried about a neck injury, that can definitely add in a layer of complexity that is difficult for someone who's not trained to manage.


Dr. Mike Patrick: Yeah, absolutely. As when we think about emergencies around pools, I want to bring Dr. Jeffrey Brown into the conversation. And, Jeff, you are a clinical psychologist, affiliated with Harvard. But you're really here to talk about personal story that impacted your family around the pool, as I understand, at the day camp. Why don't you share with us exactly what you guys experienced?




Dr. Jeffrey Brown: Sure. In 2013, we were scheduled to visit family in North Carolina for a week of just good old-fashioned summer vacation. And part of the schedule that we pulled together was to have my six-year-old son Grant participate in a day camp designed for kids his age in the community there where we had family.


We had planned this. He had been enrolled. We registered him, took him to the first day of camp, let them know that he wasn't a good swimmer, wasn't a good swimmer at all. And we were reassured that he would be watched closely, that they keep an eye on everyone.


Later that afternoon, during a period of time of free swim, my wife actually called me at the time because I was still in the Boston area seeing a few patients in my practice, then was going to fly down. She called and said that they had found Grant and were doing CPR. And my gut reaction was, "What do you mean they found him?" That means he wasn't being supervised.




And sure enough, he had managed to get in to the area of the pool that was only four feet. He wasn't in the area where we had been shown he would be for non-swimmers and swimmers who are not strong. There was one lifeguard for about 60 people in the pool.


And they had camp counselors who they'd hired as sort of watchers or camp counselor people on hand. But the person that was supposed to be watching the area where Grant was, was about seven feet from him, had no water safety training. And according to the surveillance that we've seen, her back was to the pool talking with somebody on the deck while Grant drowned.




So that so quickly, and with such poor design and poor planning on a camp that's offered to the public, that caused me to go in to the efforts of trying to change some legislation in North Carolina. Because as it is right now, anyone can have a camp in North Carolina, a day camp and put kids in the water. And there's no legislation that requires that those children be supervised by anyone of any qualification.


In fact, we were told by the camp that we were fortunate that they had one certified lifeguard watching 60 people and it was essentially a favor to us.


Any time there's a transfer of responsibility from parents to another group of adult who have organized something and offered in the public, there need to be standards of care. And I think that is absolutely indisputable. And that's what we're working toward now. We're trying to get to work done in North Carolina that should have been done well before we showed up in 2013.




And also, just trying to save the lives of kids who we'll never meet. That was a value that we shared with Grant, was that if there are people that we can help, we're going to help them. And we don't need credit for helping them. Grant wouldn't understand this arrangement about his own loss and his own drowning death.


He struggled and it's on surveillance. I've seen it. He struggled for two-and-a-half minutes to stay above water and then finally succumb and was under water for about three-and-a-half minutes, where two other children noticed his body. Two sisters, the younger sister noticed his body on the bottom of the pool and the older sister retrieved his body and got the attention of that one camp counselor that was seven or eight feet from where he was at that time.


For whatever reason, the sheriff department didn't share their report with us what happened. So we went from many, many months. In fact, we were required to send our six-year-old through probate in North Carolina to prove that we were his heirs to be able to get a copy of the sheriff's report that let us know a little bit about what happened in his drowning death.




So talk about layers of protection, there's also layers of irresponsibility that really could be avoided. And it seems so trite and so sickening to say that, but Sarah has said that already about things that are just unavoidable if they would just be done.


Humans, I'm very very interested in humans. I've been a psychologist professor on faculty at Harvard for over 20 years. I'm the psychologist for the Boston Marathon. I was there three months for the bombing, three months before Grant drowned. I'm interested in human behavior. But there's one thing that humans often think and they think they're exempt from catastrophe. They think that these things don't apply to them.




We certainly didn't go into that thinking that, "Oh, we can just throw Grant and do camp and it'll not be an issue." We communicated with camp leadership. We let them know that. They showed us where he would be, all of that failed.


All of that failed and now we have a six-year-old boy who was full of life, who was obedient, and fun, and a character and humorous laying over the cemetery. It's that fact is the truth, is that that should not happen. And every time I leave the cemetery, I always say to Grant, "Buddy, this just should not have happened the way this happened."


So we're trying to help in North Carolina get more of this legislation in place because right now the exact same risk that Grant faced that led him to bob up and down in the pool for as long as it takes to sing the national anthem, I've timed it. He did that for as long as it takes to sing the national anthem, he struggled for his life. That should not happen to any child, any child at all.




So that's why we work so hard at that and try to get the attention of people. And frankly, sometimes, we run into some very thick-skulled people who just don't think it really applies to them or doesn't happen enough or so forth. I guarantee you, if we had the opportunity to pass the law that would slightly reduce the risk of childhood cancer, we would be passing that law immediately and overnight.


This is no different because this is a leading cause. Age one to four, leading cause of death in children is drowning and we sit and we just kind of looked at it cross-eyed, not thinking that we can do anything about that.


There's this confluence that happens. Now we have a lifeguard shortage. Frankly, a lifeguard shortage and requiring lifeguard are two separate issues. Let's not get them mixed up. That's poor thinking in my opinion. And I'm sorry to be critical about that but that's poor thinking for people that go, "Well, lifeguard shortage is really going to affect this if we required lifeguard."




Well, think that really through. Think that really through that a lifeguard shortage, the idea behind it. One argument has been that, "Well, if we have to shut down pools because we don't have lifeguards, then kids aren't going to learn to swim." That's faulty thinking. That's completely faulty thinking and we can blow holes in that thinking as much as we need to.


Just because we don't have car seats, some car seat shortage, doesn't mean that, "Well, we're just going to go ahead and throw kids in the front seat. We're just going to do the best we can." We're going to come up with some alternatives until we get that problem solved but the safety issue is still the same.


Dr. Mike Patrick: Yeah, absolutely. First, I just want to say that my heart breaks for you and your family. And thank you so much for sharing that story with us. I'm just so so sorry that that happened and you guys had to experience that.




As you look back, what, you had mentioned that some of the points of failure that really did not keep Grant safe. What should parents who are in a similar situation, they're looking at a day camp, even just time at a pool, what kind of step should a parent go through in terms of ensuring that their child is going to be safe and not just hearing someone tell them "Oh, yeah, they'll be safe?" What thing should really we be thinking about and ensuring are in place?


Dr. Jeffrey Brown: Yeah, Mike, that's a great question because for just a little bit, I struggled with why didn't we stay and watch him? And then, I realized this camp was sold out. We were not the only parents who believed their child would be safe.

And the idea is that you have to be the odd man out, the odd person out, and go ahead and stay. And if the kids going to be in the water, you keep your eyes on your own kid. That's what I would have done differently. But I believed that the idea here is with the camp that's held up to the public as a structured fee for service, you're expecting standards to be met.




One of the biggest challenges we face in North Carolina is talking to people who already believe that this law that we're trying to have implemented, they believe it already exist. So, we actually did a video and said, "What do you think about repealing the required lifeguard law?" And the response was, "Oh no, you should never do that. We must have. We must have lifeguard."


It's like we don't have them. It kind of reveal it from that perspective. Lots of people believe that their kid is safe. And I think it's a faulty belief because we talk about safety and then we do have this what we call the double whammy of incompetence. Meaning that not only are we not good at something, we don't know that we're not good at something.


And that's what is plaguing a lot of this, is that it's kind of like an American Idol contestant who comes out and can't sing very well but they think they're going to be the next Idol. It's like you've got to really look at you're thinking as an administrator, as a camp administrator.




The idea that, "Well, if it doesn't happen to me, it really doesn't happen." That doesn't apply any longer and it doesn't apply. I promise you. I promise you. I promise you. You do not want to learn it the hard way. There is nothing worse than losing your child. I don't care how you lose your child, there is nothing worse than losing your child. Take it from people who have suffered daily because of this.


So that's why we have to be woken up to the idea that we need to have some things in place. We're not asking for the moon here. In North Carolina, we need to have some basic things like a basic swim test. And we need to have a lifeguard ratio I believe of 2 to the first 25. The old antiquated 1 to 25 ratio has been around since the previous century and no one seems to really know how that came about.




But if you think about it again, common sense, if you have 25 kids in a pool, you have 1 certified lifeguard and you have one event, the lifeguard goes in the pool and this is exactly what happened for Grant. The one lifeguard that was there for 60 went in to attend to him and now you have 59 people who are unsupervised in the water. So you must have that second person there, period.


Second piece to happen was once they begin CPR, there's only one certified CPR person there helping. And that person fatigued after 11 minutes of trying to resuscitate. I saw the video I believe Grant was gone when he was pulled from the water. And I appreciate the efforts made to resuscitate him. But that fatigue that goes in with that is another reason why we need that.


Also, Maria Bella, I don't know if you recognize her name but she's a water safety expert, forensic expert, and she said some fabulous research that all pool level vision needs to be at least six feet. Six feet gives you a better perspective on kids who are under the water.




So there are some basic things here that need to happen. As it is now, and it sounds like ludicrous that I would have to say it this way, but any of us on this call could travel down to North Carolina, decide to have a day camp, put up posters on telephone poles, rent a pool at a motel and load that pool up with kids. And there's no responsibility for us as the pool or camp operator to make sure those kids are safe in that water. And that just blows my mind.


Dr. Mike Patrick: And I'm sure that there are other states in similar situation, not just North Carolina. From a legislative point of view with their elected officials, sort of the same thing that you're doing in North Carolina right now, it seems that that could be looked at in other states. What can parents do if they wanted to advocate in that way?




Dr. Jeffrey Brown: Right. I think it does have to happen that way. I think you have to reach out to legislators. We're fortunate to have a bill sponsor, still recruiting additional bill sponsors. My hope is that the bill, when it is actually written and goes into motion will be very bipartisan.


We shouldn't have conflict in discussion around kid's safety. This should be the biggest no-brainer bill ever put in play because it's going to increase a layer of safety and it's going to allow as to know that we have trained people doing the right job.


You see, part of the reason here is fiscal. We've got this through our own investigation and on deposition that, well, it's a little bit cheaper to hire a camp counselor than it is a certified lifeguard, $2 or $3 cheaper.




So, when you say in the black for camp so we can operate with good numbers, so we can show that we are doing a good job, we can have camp again, I would pay whoever by the hour for the rest of Grant's life if I can have him back. That would be no big deal. I would figure that out.


So that little narrow margin of greed, there's a lot of greed around that. I call it green water when pool water gets greedy somehow. And that's part of this scenario with not hiring certified lifeguards and was hiring somebody that stands in for that.


Dr. Mike Patrick: And not just the difference in salary but if you have a law that required lifeguards and there's a shortage of lifeguards, you might not be able to open your pool. And then people might not come to your camp and that also comes down to money.


Dr. Jeffrey Brown: Right, right. I've also been looking at some of the possible insurance benefits that you may actually have by employing lifeguards, that you're overall liability will go down. I'm fairly certain that if your insurer knows that you're having a camp full of kids but you don't have lifeguards, you're going to be pre-paying a higher insurance premium for that risk.




Dr. Mike Patrick: Sarah, I want to bring you back in the conversation here for just a moment. As you listened to Jeff's family story, I'm sure some thoughts come in your mind in terms of advocating for families. And I feel like maybe you would have a good question for him that I'm not thinking of.


Dr. Sarah Denny: Well, first of all, I just want to say, Jeff, I'm so so sorry. That is awful. And I am so impressed that your family has embraced this advocacy opportunity here because, I mean, you're right. I mean, it sounds like just a lot of things that went wrong and it ended in tragedy. So, thank you for sharing your story but also what you continue to do.


And I just wanted to add, Mike, as you were saying is there are tremendous opportunities for advocacy in drowning. In fact, we're not doing enough advocacy.




I've been to DC. I've done a congressional briefing on potentially a national prevention drowning agenda. Many other countries have high drowning rates such as Australia have these things established. But families and injury prevention experts can advocate within your community, just even at your local pool, advocating within the state or on the national scene, advocating for policy that does put into effect laws that help keep our kids safe around water.


Dr. Jeffrey Brown: I would also submit that one of the best organizations is the National Drowning Prevention Alliance, tremendous group of people. And in that group is a subgroup called Families United. And Families United is kind of special membership that you have to have lost a family member to drowning.


But the National Drowning Prevention Alliance, I met just last few months ago in Fort Worth, and it talk about advocacy and the latest and greatest ways of thinking about drowning prevention, everything from technology to basic pool safety at home. That's a group that you can find easily online.




The president of that group Adam Katchmarchi is tough notch. He's been one of our tough expert panels. We have dealt with the Child Fatality Task Force in North Carolina trying to get them to endorse this legislation. They actually did come through with the endorsement that they believe lifeguards are deficient layer of safety and so forth.


So, it's a no-brainer and it is nice to have there's stamp on that effort. But it's certainly is there are this group, as Sarah is mentioning, different layers even with your hometown. Running a little shelter close to the beach that has life jackets and making sure that life jackets are stored and replenish. Just some things like that do make a difference.




Dr. Sarah Denny: Jeff, what a powerful group because you have that personal story and you have all these data to back up what you're saying. We know drowning is a huge problem in this country and we need to be very actively engaged, all of us, in making this not a problem anymore. This is preventable and if we have the right things in place, then we should be able to prevent these tragedies.


Dr. Jeffrey Brown: So true, so true.


Dr. Mike Patrick: I'll put a link in the show notes to the National Drowning Prevention Alliance so folks can find them easily over at in the show notes for this episode.


Another resource I wanted to mention, Sarah, you were the lead author on an AAP American Academy of Pediatrics Policy Statement that was published in the Journal Pediatrics in May of 2019 called Prevention of Drowning. Tell us about that resource.




Dr. Sarah Denny: Yeah. So the Policy Statement Prevention of Drowning is actually is the condensed version of the Technical Report which came out later and is much more lengthy. And it really dives into the science behind the recommendations we make in the policy statements. So the policy statement are kind of through that whole process. What we did is we looked at the previous policy statement and we did an entire review of the literature. So this policy statement technical report are based on science, based on the evidence, studies that been done.


And not just in the US, but I mentioned Australia. They have a huge network of research going on in water safety because obviously they have a lot of natural water pools that type of thing. So we reviewed all the literature and went through and adjusted the recommendations where needed, as the evidence let us and made these recommendations to families, to people who are operating pools, and also around advocacy. What can we do to be advocates within our community to help promote a safer swim environment?0




Dr. Mike Patrick: I'll put a link to that policy statement in the show notes as well, so folks can find that. And then finally, Sarah, I had mentioned at the beginning of our time together that you are co-director of the Resident Advocacy Education Program at Nationwide Children's. Tell us about that.


Dr. Sarah Denny: Well, as you probably can tell I'm super passionate about Child Injury Prevention. And so as part of that work, clearly, policy plays a really important role. We know that we can do so much regarding teaching and counseling but really it's that legislative piece that helps move the needle.


Jeff, you brought up car seat safety. We knew car seats were good for kids for a really long time and we talked about it and talked about it. But it was until the policy piece came in that we see it fairly uniformly that people use child passenger seats.


And so, part of my job is to teach residents how to be effective advocates for kids. And that can be around child injury, child help, access to care, all types of things. And for some people that means legislative advocacy. For others it means community partnership.




So, Jeff mentioned some of the partners that they worked with. Community partnership is really important because if you have an idea or you have an issue you want to work on, most likely there's someone who's also doing that work. And so, joining forces and leveraging kind of the power of both of your groups can be very very powerful. So, I really enjoy working with these young pediatricians and how teaching them how to be the best pediatricians that kids need.


Dr. Mike Patrick: Yeah, that's really fantastic part of the residency program here at Nationwide Children's Hospital. And I'll put a link to that program in the show notes as well.


Dr. Sarah Denny: Thank you.


Dr. Mike Patrick: So once again, I want to thank both of you for being here today as we've talked about water safety and drowning. Lots of links in the show notes, so please check those out over at, this episode 520. And you'll be able to find those easily.




And then once again, Dr. Sarah Denny with Primary Care Pediatrics at Nationwide Children's Hospital, and Dr. Jeffrey Brown from Harvard Medical School, clinical psychologist. Thank you both so much for stopping by and chatting with us today.


Dr. Jeffrey Brown: Thanks, Mike.


Dr. Sarah Denny: Yeah, thanks for covering this important topic. I'm so glad that we're talking about it.


Dr. Jeffrey Brown: You bet, you bet.






Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests, Dr. Sarah Denny with Primary Care Pediatrics at Nationwide Children's Hospital, and Dr. Jeffrey Brown, clinical psychologist at Harvard Medical School.


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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.






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