Symposium: accidents and poisoningManagement of drowning in children

Drowning has historically been a significant cause of morbidity and mortality in children. It characteristically affects unsupervised toddlers and thrill-seeking teenagers. Through prevention rather than treatment we have seen a tremendous reduction in the number of drowning victims, although in less well-developed countries, which are less able to provide education and enforce safety measures, the burden remains large. In the developed world domestic pools remain a risk. The international community has agreed on a definition of drowning as 'the process of experiencing respiratory impairment from submersion or immersion in a liquid'. This replaces all previous terms including 'near drowning'. If prevention has failed, survival from drowning is dependent on immersion time, on-scene resuscitation and subsequent intensive care management. The critical problem is hypoxia and this must be relieved as soon as possible if there is to be a favourable outcome. Extraction should not put the rescuers at risk but should be as quick as possible so that resuscitation can commence. Intensive care management can further improve outcomes, although further doubt has been cast on the role of therapeutic hypothermia following cardiac arrest. Of all the causes of paediatric out-of-hospital cardiac arrests it must be borne in mind that those secondary to drowning have the best outcomes.