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Current Trends Child Drownings and Near Drownings Associated with Swimming Pools -- Maricopa County, Arizona, 1988 and 1989

In Arizona, drowning* is a leading cause of fatal injuries among children less than or equal to 4 years of age (1). From 1981 to 1988, the annual rate of death from drowning for children in Arizona ranged from 9 to 15 per 100,000 children less than or equal to 4 years of age; from 1985 to 1987, the average annual rate for the United States was 4 per 100,000 children in this age group.

In April 1988, to help characterize the problem and to identify opportunities for intervention, the Arizona Department of Health Services requested that fire departments in Maricopa County (the Phoenix Standard Metropolitan Statistical Area; population, approximately 2 million) use a standard form to report drowning and near-drowning** incidents. In Maricopa County, fire departments are the first responders to 911 emergency telephone calls. From January 1988 through December 1989, fire departments recorded 243 calls for drownings and near drownings involving children less than or equal to 4 years of age. Of these, 206 (85%) occurred in swimming pools (Maricopa County has an estimated 125,000 public and private swimming pools); 23 (9%), in bathtubs; and 14 (6%), in other bodies of water (e.g., buckets, toilets, and ponds). Of the 206 swimming pool incidents, 111 (54%) occurred from May through August. Detailed report forms were available for 137 (67%); of these, 94 (69%) occurred at residences.

Based on review of these forms by state and county health department and fire department personnel to determine opportunities for intervention, 55 (40%) of the 137 incidents were attributed to a lapse in supervision; 48 (35%), to absence of a pool fence (i.e., a fence that completely encloses the pool and isolates it from the house and play area); 19 (14%), to an inadequate or unclosed gate or latch; three (2%), to an inadequate fence; and 12 (9%), to other causes.

The proportion of drownings and near drownings considered preventable by a pool fence was higher during the colder months (October through April, 29 (56%) of 52 drownings and near drownings) than during hotter months (May through September, 19 (22%) of 85).

Substantial morbidity and mortality also occurred among persons who were admitted to hospitals for near drowning. Of 398 children admitted to a major children's hospital in the state from July 1982 through July 1989 for near drownings, 74 (19%) died, and 36 (9%) were discharged as neurologically impaired (Phoenix Children's Hospital, unpublished data, 1989). Reported by: TJ Flood, MD, M Aickin, PhD, Div of Disease Prevention, SJ Englender, MD, State Epidemiologist, Arizona Dept of Health Svcs; D Tucker, Phoenix Fire Dept, Phoenix, Arizona. Unintentional Injuries Section, Epidemiology Br, Div of Injury Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Factors possibly associated with the increased risk for child drowning and near drowning in Arizona include the state's numerous swimming pools, relatively higher temperatures, and relatively longer outdoor swimming season.

Reports from Australia and New Zealand suggest that pool fencing alone could substantially reduce childhood drownings in pools in those countries (2,3). Data from Maricopa County suggest that pool fencing, in combination with adequate gates and latches, could have prevented 70 (51%) of the 137 drownings or near drownings reported. Because 40% of the incidents were attributed to a lapse in supervision (i.e., the supervisor's attention was diverted or a child was momentarily unobserved while the adult performed a chore in the pool area), educating parents about constant vigilance at a pool should complement an emphasis on passive barriers to the pool. To reduce the higher proportion of deaths preventable by pool fences in winter months, when supervision tends to decrease around the pool environment, education should emphasize the need to maintain vigilance if the pool is not drained.

Measures to reduce childhood drownings and near drownings in Maricopa County have included mandatory fencing and barriers around swimming pools and educational campaigns conducted by Maricopa County fire departments to increase the public's awareness of child safety relating to water recreation. Other measures have included instruction on the maintenance of gates and latches, cardiopulmonary resuscitation classes, and requests of the swimming pool and home building industries to improve the design and placement of pools.


  1. CDC. Childhood injuries in the United States. Am J Dis Child 1990;144:627-46.

  2. Langley J. Fencing of private swimming pools in New Zealand. Community Health Stud 1983;7:285-9.

  3. Pearn J, Nixon J. Prevention of childhood drowning accidents. Med J Aust 1977;1:616-8. *Arizona uses the following International Classification of Diseases, Ninth Revision, rubrics to define child drowning: E830, E832, E910, E984. **In this report, near drowning is defined as a life-threatening incident in which the child was apneic or pulled from under the surface of the water. Outcomes of near-drowning incidents were not tracked for the Maricopa County study; incidents in which the child was struggling or both floating and breathing when rescued were not counted as near-drowning incidents.

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