Toddler drowning prevention: Teaching parents about water safety in conjunction with their child's in-water lessons

Using ERIC to Assess Implementation Science in Drowning Prevention Interventions in High-Income Countries: A Systematic Review

This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.

The "DrownSafe" Project: Assessing the Feasibility of a Puppet Show in Teaching Drowning Prevention to Children and Parents

Drowning remains a prominent global pediatric health concern, necessitating preventive measures such as educational initiatives for children and caregivers. In this study, we aimed to assess the feasibility and educational effectiveness of an interactive puppet show centered on teaching water safety to children and parents. A 30 min original theater performance, featuring two actors and three puppets (a girl, a crab, and a lifeguard), was conducted. Subsequently, 185 children (aged 4 to 8) and their 160 parents (134 mothers and 26 fathers) participated in this quasi-experimental study. Pre- and post-show tests were administered to evaluate knowledge and behaviors regarding aquatic environments. Prior to the puppet show, 78% of the children exhibited basic aquatic competency. Only 33% considered swimming alone risky. Following the intervention, 81.6% of the children changed their perception of the risks of solo beach activities, showing improved knowledge regarding contacting an emergency number (from 63.2% to 98.9%, p < 0.001). The intervention increased parents' intention to visit lifeguard-patrolled beaches and improved their CPR knowledge with regard to drowning victims by 58.8%. In conclusion, a drowning prevention puppet show positively impacted children and parents, potentially enhancing safety behaviors during water-related leisure activities, warranting its consideration part of comprehensive drowning prevention strategies.

Building the Foundation of Aquatic Literacy in 4-6 Years-Old Children: A Systematic Review of Good Pedagogical Practices for Children and Parents

Children between the ages of 4–6 years represent the population most affected by drowning accidents, while their early involvement in physical activity, and more specifically in aquatic activities is a key factor in their future physical life journey. The systematic review’s purpose was to identify aspects in the intervention’s studies with children and/or their parents that had a significant impact on the Aquatic Literacy (AL) dimensions mentioned as motor, psychological, affective, and cognitive. The PICO method was used to define the research question and PRISMA checklist searched for articles in nine databases: Cochrane, Embase, ERIC, ProQuest, PsychInfo, PubMed, Scopus, SportDiscus, and Web of Science. Eligibility criteria were: (1) English language, (2) primary research, (3) population of 4–6 year old children or their parents, (4) intervention study design, and (5) results related to at least one of the AL domains. The strength of evidence and the risk of bias were assessed. Results showed relatively poor number of studies for such a vulnerable population regarding the drowning risk (n = 8 for parents and n = 14 for children intervention). Studies did not show a consensus on which educational approach was more beneficial than others. Concerning parental education, results were rather homogeneous, especially concerning the theoretical frameworks employed and the relevancy to include parents in swimming programs. The development of pedagogical tools for promotion and evaluation, based on the AL theoretical framework, could help to clarify the question of “how to teach” children to prevent drowning and engage young children in long-term physical activities.

Effectiveness of "Be SAFE Drowning Prevention and Water Safety Booklet" Intervention for Parents and Guardians

Background:

We aimed to assess the effectiveness of the health educational booklet intervention in improving parents/guardian’s knowledge on prevention of child drowning and, the perception of drowning risk and water safety practice.

Methods:

A quasi-experimental study was conducted in year 2017 in Selangor, Malaysia among 719 parents/guardians of primary school children. The parent/guardians were randomly assigned as the intervention groups and were given a health educational Be-SAFE booklet on drowning prevention and water safety. The pretest was conducted before the intervention and posttest was done one month of intervention. The data collection tool was using a validated questionnaire on knowledge, attitude and practice for drowning prevention and water safety.

Results:

There were 719 respondents (response rate of 89.9%) participated at baseline and 53.7% at end line (after the intervention). Significant differences found in knowledge, attitudes and practice on drowning prevention and water safety for the intervention and control groups after the intervention (P<0.001). There was a significant difference in mean scores for knowledge and attitude before and after the intervention, whereas no significant findings noted for practices (P<0.001).

Conclusion:

Be SAFE booklet contributed to the increase in parents/guardian’s knowledge and attitudes towards drowning prevention and water safety to prevent the risk of child drowning.

Learning to Swim: An Exploration of Negative Prior Aquatic Experiences among Children

Learning to swim via a structured program is an important skill to develop aquatic competencies and prevent drowning. Fear of water can produce phobic behaviors counterproductive to the learning process. No research examines the influence of negative aquatic experiences on learning to swim. This study explored the influence of children’s negative prior aquatic experiences (NPAE) on learn-to-swim achievement via swim school data. Children’s enrolment records (5–12 years) in the Australian Capital Territory were analyzed via demographics, level achieved and NPAE. NPAE was recorded as yes/no, with free text thematically coded to 16 categories. Of 14,012 records analyzed (51% female; 64% aged 6–8 years), 535 (4%) reported a NPAE at enrolment. Males, children with a medical condition and attending public schools were significantly more likely (p = 0.001) to report a NPAE. Children reporting a NPAE achieved a lower average skill level at each year of age. The largest proportion (19%) of NPAE reported related to swimming lessons. NPAE have a detrimental influence on aquatic skill achievement. We recommend increased adult supervision to reduce likelihood of an NPAE occurring, while also encouraging swim instructors to consider NPAE when teaching swimming and develop procedures to ensure a NPAE does not occur during instruction.

S.A.F.E.R. Near Water: An Intervention Targeting Parent Beliefs About Children's Water Safety

OBJECTIVE

The current study aimed to develop, implement, and evaluate the S.A.F.E.R. Near Water program, an evidence-based and theory-driven intervention targeting parent beliefs relevant to keeping children safe around water.

METHODS

A nonrandomized trial was conducted. Parents with children aged two through five years who were enrolled in lessons either at a public or private swim organization in Ontario, Canada were recruited and nonrandomly assigned to either an Intervention (N = 92) or Control (N = 150) condition. All parents completed the same questionnaire measures two times over the course of their child's swim lesson session period, once at the beginning (preintervention) and again at the end (postintervention; approximately 9-15 weeks later). Questionnaires assessed parents' perceptions related to supervision, child drowning risk, water safety, and optimism bias. Parents in the Intervention condition participated in S.A.F.E.R. Near Water, an educational water safety program comprising in-person seminars, informational handouts, and posters.

RESULTS

The S.A.F.E.R. Near Water program was associated with increased knowledge in targeted areas and effectively communicated most of the intended messages. A series of primary regression analyses revealed that parents receiving S.A.F.E.R. Near Water demonstrated improvements in: beliefs about the value of supervision; judgments about children's swim skills and drowning risk; and perceptions related to swim lessons and children's supervision needs (sr2 range: 0.22-0.38).

CONCLUSION

These findings provide support for the feasibility and usefulness of a multifaceted, parent-focused, educational program delivered alongside children's swim programming to promote closer adult supervision of children around water.

Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Infant and toddler drowning in Australia: Patterns, risk factors and prevention recommendations

Drowning is a leading cause of death among infants and toddlers. Unique physiological and behavioural factors contribute to high mortality rates. Drowning incidents predominantly occur during warmer months and holidays. Recent studies link high socio-economic status and drowning, in contrast to earlier studies. Cardiac arrhythmias, epilepsy and autism are strong risk factors for drowning incidents. Prevention strategies have substantially lowered drowning rates. While legislation-compliant pool fencing substantially reduces drowning risk, compliance levels are low, and penalties are minor. Active supervision education for parents and carers is an effective drowning prevention strategy. Bystanders provide basic life support in only 30% of cases; strategies to increase training uptake are needed. Fencing costs should be a mandatory inclusion for pool installations, with high penalties for non-compliance. Basic life support training should be compulsory for pool owners, and tax incentives should be used as a lever to increase training uptake.

Is There an Optimal Age for Learning to Swim?

Longitudinal records were examined for 272 children who started formal swimming lessons at 3, 4, 5, 6, 7, or 8 years of age. The groups of children were compared on the number of lessons and number of months required to reach three levels of swimming proficiency and the ages at which these levels were reached. Significant differences were found in the ages at which each proficiency level was attained. The younger the age at which children started lessons, the younger they were when they attained Level 1 proficiency. In contrast, the ages at which Level 2 and Level 3 proficiency were attained were more similar, particularly for the younger starters. Significant differences were found for the number of lessons and number of months required to reach Level 1 proficiency and to progress from Level 1 to Level 2 proficiency. The younger the starting age the more lessons and months required to reach each proficiency level. The pattern of findings suggests that the optimum age to begin formal swimming lessons is between 5 and 7 years of age. The findings are discussed relative to the literature on readiness and sensitive periods for learning.

Interventions associated with drowning prevention in children and adolescents: systematic literature review

INTRODUCTION

Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents.

METHODS

A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0-19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied.

RESULTS

Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2-4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these.

CONCLUSIONS

Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.

Drowning risk perceptions among rural guardians of Thailand: A community-based household survey

Drowning is one of the most common causes of death among young children in Thailand. Children in primary school in rural settings have a high rate of fatal drowning. Guardians' perceptions are important since children are normally in their care. This study aims to describe drowning risk perceptions of guardians and to identify barriers to developing a child's swimming skills. A cross-sectional household survey was conducted among guardians of children who attended 12 schools serving 48 villages in a rural community. The results revealed that less than one-fifth (18%) of children in the household could swim. Guardians reported that children should learn to swim at the age of seven years. About one-quarter (23%) of guardians did not perceive drowning as the leading cause of death among children. More than a quarter (25.4%) perceived that their child was not at the risk of drowning. No statistical differences were reported on drowning perception among guardians with different swimming skills as well as child's swimming skill. Significantly more parents of children who could not swim perceived lack of swimming instructors, clean water and school swimming lessons as barriers to a child's acquisition of swimming skill. The results highlight the need to consider improving the infrastructure in rural areas to facilitate swimming skills for school children to reduce drowning risk.

Case analyses of all children's drowning deaths occurring in Sweden 1998-2007

AIMS

The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007.

METHODS

Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children's personal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death.

RESULTS

Our analysis showed that 109 children had drowned in Sweden during the study period - of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim.

CONCLUSIONS

Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.

Crossing safety barriers: influence of children's morphological and functional variables

Thirty-three children between 3 and 6 years of age were asked to climb four different types of safety barriers. Morphological and functional variables of the children, which were expected to influence climbing or passing through skills, were collected. The influence of those variables on children's success rate and time to cross was tested. No barrier offered a total restraining efficacy. The horizontal bars barrier was crossed by 97% of the children. In the group of children that succeeded in crossing the four barriers, mean time to cross the most difficult barrier was 15 s. Age was the best predictor for success in crossing most barriers but morphology and strength were important predictors of time to cross. The influence of anthropometric variables in time to cross was dependent upon the characteristics of the barrier. A good design of safety barriers should consider children's age, morphology and strength.

Prevention of drowning

Drowning is a leading cause of injury-related death in children. In 2006, approximately 1100 US children younger than 20 years died from drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Child drowning deaths in Xiamen city and suburbs, People's Republic of China, 2001 5

BACKGROUND

Risk-factor research and prevention programs targeting drowning deaths in children have been well developed in industrialized countries, but little research has been undertaken in developing countries where the majority of drowning deaths occur. We conducted an epidemiological study to describe the sociodemographic characteristics, drowning circumstances, and medical service in drowning deaths of children in Xiamen city and suburbs, People's Republic of China.

MATERIAL AND METHODS

Drowning deaths in 1-14-year-old children between 2001 and 2005 were identified using death certificates. Parents of each case were interviewed face to face about the sociodemographics of the family and child, the drowning event, and medical care received. Mortalities were calculated using census data for urban and rural areas, and Poisson regression was used to evaluate confounding effects and interactions of several major risk factors for drowning death.

RESULTS

Of 67 drowning deaths identified, 52 (77.6%) were males. A higher proportion of deaths were in children aged 5-9 years (40.3%) and 10-14 years (40.3%). The drowning mortality per 100 000 population was 5.84 in rural areas and 0.75 in urban areas. Drowning events occurred most commonly during the summer months (56.7% from June to August), during the hours of 13:00-17:59 (62.7%), and in natural or man-made bodies of water (eg, ponds, ditches, construction sites, and wells). None of the children were proficient swimmers, the majority of drowning events (88.1%) occurred in the absence of adult supervision, and 86.6% children died at the scene without any medical care. Results from muiltivariable Poisson regression analysis indicated that 10-14-year-old boys were at the highest risk of drowning deaths in this area.

DISCUSSION AND CONCLUSIONS

Drowning deaths in children in Xiamen city and suburbs follow trends that are markedly different from patterns observed in other countries. Different prevention strategies may be required for preventing child drowning deaths in Xiamen and other developing regions.