Drowning in children

Drowning is one of the leading causes of death in children. The highest-risk groups are children under the age of five and males aged 15 to 19.

What is Drowning?

Drowning is defined as an event that occurs due to submersion in a liquid medium, resulting in respiratory impairment, according to the World Congress on Drowning held in Amsterdam in 2002.

According to the World Health Organization, drowning is the third leading cause of unintentional injuries worldwide, accounting for 7% of all injury-related deaths. Globally, approximately 372,000 people die from drowning each year, with the majority (90%) occurring in economically less developed countries. Drowning ranks among the top ten causes of death in children and young people. Infants and male adults are at the highest risk. In Croatia, in the last five-year period (2009-2013), drowning was the fourth leading cause of death from unintentional injuries, following falls, road accidents, and poisoning, with an average rate of 2.3 per 100,000. Source: Croatian Institute of Public Health.

Pathophysiology of Drowning:

Drowning leads to prolonged hypoxia, resulting in the development of acidosis. During drowning, breath-holding and apnea occur, and if hypoxemia persists, it can lead to unconsciousness and cardiovascular disturbances without aspiration of fluid. Attempts to breathe result in fluid entry into the airways. Contact between fluid and the epiglottis triggers laryngospasm, which quickly subsides, allowing fluid entry.

A certain portion of drowning victims (10-20%) retains laryngospasm until complete cardiac arrest, resulting in minimal fluid in their airways. The “diving reflex” can occur in small children who drown in water colder than 20°C, causing apnea, bradycardia, and peripheral vasoconstriction.

Prolonged hypoxemia leads to loss of consciousness, and irreversible central nervous system changes occur within 4-6 minutes. Hypothermia before hypoxemia is considered a protective factor for the central nervous system.

Factors Affecting Treatment Outcomes and Assessment of Therapy Implementation:

  • Age of the drowning victim
  • Time spent underwater
  • Water temperature
  • Degree of contamination
  • Associated injuries
  • Medical history
  • Time and method of rescue
  • Response to initial resuscitation


  1. Check for safety and eliminate dangers.
  2. Early Basic Life Support (BLS).
  3. Artificial respiration can be performed in the water during rescue, but chest compressions should not be conducted in the water as they require a firm surface.
  4. Extrication from the water should be done in a horizontal position to avoid cardiovascular collapse due to the loss of evenly distributed pressure.
  5. Always consider potential spinal injuries (immobilization, neutral head and neck position).
  6. ABCDE approach (ensure airway, adequate oxygenation, and ventilation).
  7. While checking the airway, inspect and remove possible obstructions.
  8. Administer 100% oxygen.
  9. Exercise caution with hypothermia.
  10. Neurological assessment (Glasgow Coma Scale).
  11. Physical examination.
  12. Monitor vital signs (heart rate, SpO2, blood pressure, temperature, and more).
  13. Secondary examination (all injuries).
  14. Laboratory tests (complete blood count, urea, creatinine, glucose, electrolytes, arterial blood gases, coagulation tests, toxicological screens).
  15. Imaging (X-ray, CT scan, and others as needed depending on injuries).


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