Shallow Water is Dangerous Too
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Hello, first-time commenter here. I happen to maintain current certifications as a lifeguard and Wilderness EMT. I suffered four non-fatal drownings as a kid myself (https://kycuong.com/drowning/).
I'm really glad your daughter turned out okay! That's a frightening close call. I wanted to pass on some general insights I've learned from my training and research. It's US-centric for the bodies I cite, but many of the US recommendations are reflected by other organizations abroad.
General knowledge I think most readers would find helpful
- Drowning can occur anytime the airway is compromised by liquid. The WHO defines drowning as “the process of suffering respiratory impairment from submersion/immersion in liquid”. Children drown in buckets, bathtubs, even toilets. As unfortunately demonstrated here, standing depth is not necessarily safe depth.
- Drowning is silent. Once someone is drowning, they cannot shout or even wave for help. Most people don't recognize what it looks like. Prevention and rapid recognition + response are vital.
- Inflatable arm floats, inner tubes, and other "floaties" are fun, but no substitute for proper life jackets. Arm floats can slip off and there are many examples of children flipping over/off pool toys and ending up in trouble. A life jacket is designed to keep someone's airway above water even if they are unresponsive (e.g., they hit their head when their boat capsized).
Some specific recommendations
- Safety engineering principles apply here. Safety-I focuses on preventing things from going wrong. It would emphasize approaches like defense-in-depth à la the Swiss Cheese Model: barriers around bodies of water, adult supervision, swim lessons, life jackets, and CPR/AED training. (Table 1 in "Preventing Drowning" from the American Academy of Pediatrics)
- Safety-II would emphasize what makes things go right: rotation and non-distraction in adult supervision; destigmatizing the use of life jackets; correctly sizing life jackets and ensuring they meet USCG standards); picking a beach with lifeguards, and so on. (Table 3)
- The American Academy of Pediatrics now recommends starting swim lessons as early as age 1. The concern that swim lessons introduce a moral hazard ("My kids took swim lessons, therefore I no longer need to monitor them") is not borne out by the evidence. In fact, swim lessons are a perfect touch-point for educating parents on the importance of adult supervision (see "Swimming Lessons, Water Survival Training, and Water Competency"). More fundamentally, swim lessons introduce the water competency children will need in lakes/rivers/oceans, provide a final line of defense if other measures failed, and extend the time available for help to arrive.
- I personally no longer ask "Do you know how to swim?" but instead "What training have you had in swimming?" People have very different assumptions on what "knowing how to swim" means. The American Red Cross defines water competency as the ability to enter water you cannot stand in, return to the surface, float or tread for at least 1 minute, turn around, swim 25 yards, and exit the water. This is the ability to survive an unplanned plunge into a standard-length American pool.
- Open water swimming is my personal passion as a triathlete, but is its own beast. See recommendations from the United States Lifesaving Association (the standards body for ocean lifeguards) and the National Center for Cold Water Safety.
Reference Resources
American Red Cross Lifeguarding Manual. 2024. American Red Cross Training Services. https://www.redcross.org/store/american-red-cross-lifeguarding-manual/755740.html.
Davis, Christopher A., Andrew C. Schmidt, Justin R. Sempsrott, Seth C. Hawkins, Ali S. Arastu, Gordon G. Giesbrecht, and Tracy A. Cushing. 2024. “Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update.” Wilderness & Environmental Medicine 35 (1): 94–11. https://doi.org/10.1177/10806032241227460.
Denny, Sarah A., Linda Quan, Julie Gilchrist, et al. 2021. “Prevention of Drowning.” Pediatrics 148 (2): e2021052227. https://doi.org/10.1542/peds.2021-052227.
Dow, Jennifer, Gordon G. Giesbrecht, Daniel F. Danzl, Hermann Brugger, Emily B. Sagalyn, Beat Walpoth, Paul S. Auerbach, et al. 2019. “Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update.” Wilderness & Environmental Medicine 30 (4S): S47–69. https://doi.org/10.1016/j.wem.2019.10.002.
National Center for Cold Water Safety: https://www.coldwatersafety.org.
Sempsrott, Justin R., Andrew C. Schmidt, Seth C. Hawkins, and Tracy A. Cushing. 2016. “Drowning and Submersion Injuries.” In Auerbach’s Wilderness Medicine, 7th Edition, 1530–1549. Elsevier.
Vittone, Mario. 2020. “What Drowning Really Looks Like.” Divers Alert Network. February 1, 2020. https://dan.org/alert-diver/article/what-drowning-really-looks-like/.
Open water swimming is my personal passion as a triathlete, but is its own beast.
I know you know this, but for anyone reading along: Open water can be an absolute nightmare, even when it looks safe, and even when the distance is short.
I used to be on the swim team. I could swim a mile, and I could swim 25 meters on about 2 breaths of air. And then one day, I attempted to cross maybe 50 meters of open water with small waves (4-5 inches, max), on a very windy day. I wound up repeatedly inhaling salt water when the wind broke the wavecaps into spray. I'm not entirely sure I would have survived what should have been a trivial swim, at least not without doing it in several long, underwater stretches. Happily, I had planned ahead and I was swimming within easy reach of a rowboat.
I have also done whitewater kayaking, with a good lifevest and a helmet, plus a wetsuit until the water is comfortably warm. (One classic kayaker rule of thumb is to always wear a wetsuit if the air temperature plus the water temperature is less than 120F.) One of the things that really viscerally surprised me is cold shock. I knew all about hypothermia. But the first time that I hit cold May water in a wetsuit and suddenly lost 50% of my swimming ability within 20 seconds was still a surprise.
Adding my anecdote:
The closest I have come to drowning was in about 6 inches of water, and I was 10 years old!
I was at a playground with water features and there was a little bridge over a little stream, and I looked at it and thought "I bet I could fit through there!" I was old enough that I really should have realized this was a bad idea, but... didn't, until I found myself with my head perfectly wedged under the bridge, face down in the water.
As is common in moments of panic, I was stuck for only a few seconds but it felt like an eternity. My parents were far enough away that I didn't think they'd notice (because they very reasonably thought I was old enough to take care of myself on a playground), and I wasn't sure anyone else would either - even if I thrashed around, adults not looking too closely might think I was just splashing and playing. I remember thinking "wow, this is it, this is how I die, what a dumb way to go!"
After a few seconds of wriggling I became unstuck and was fine, but it was definitely a wake-up call about how seeming dangerous and actually being dangerous are not the same thing.
I'm glad she's totally fine. Maybe even a net positive for her and the family on future water safety. It showcases the importance of thinking about bodies of water beyond the prototypes.
A somewhat similar event occurred last weekend with my toddler in a pool. I was less than a foot away from him, as intended, and he was walking around in waist-deep water. Lost his feet but his waist is taller than his arms are long - so he needed me to intervene. He swallowed a little water in the less than two seconds he was sloshing around, but he otherwise didn't care.
The lesson is the same: the bottom needs to be reliable enough that they can regain footing + footing may mean arm lengths + you basically can't count on buoyancy/control (even if he had his arms straight out he might not know how to properly keep his head out, he might not know to hold his breath, and also he might be panicking) = don't go swimming alone.
The lesson is the same: the bottom needs to be reliable enough that they can regain footing
My mother was a trained lifeguard, and the lesson is more general than that: Young children can and do drown in a few inches of water. This is apparently a well-known risk, at least among lifeguards. I don't know all the mechanics of this, or what the age cutoff is, but it is something that lifeguards are (or at least were?) taught to watch for.
I teach lifesaving, and it is true that children can drown in even very shallow water. At the most basic mechanical level, you just need to be able to find a head position where they are lying down with both nose and mouth submerged for it to be possible. I once collected drowning data from a coroner's office, and its really sad how many children drown when their mum gets a phone call during bath time.
I suspect that most people assume water depth is a good metric for safety, and that its actually quite a bad way of measuring it. If you have someone who can swim, then it doesn't matter if the pond is ten-thousand leagues deep. If they become unable to swim (eg. they have an epileptic seizure, or hit their head and fall unconscious, or try and hold their breath underwater and fall unconscious, get into a playfight with a sibling and get pushed under the water, become entangled in a net, become confused, or are so surprised to fall in that they freeze, or accidentally breath in water and start panicking) then it doesn't make that much difference if its only 30cm deep, that is still deep enough to immerse the face.
I would guess that the difference between being supervised, and not, is much much bigger than the difference between 10cm and 10,000km.
"Shallow enough to stand up", while presumably somewhat important, is not an all-important break point, because most things that would disrupt your ability to swim (confusion, unconsciousness, injury, panic, entanglement, cold water shock) might also disrupt your ability to stand.
In this case it sounds like the child, after landing in the water, was so surprised/shocked by it that she froze, and didn't put her legs down. (I would guess the claim afterwards that she couldn't was rationalization, and that the real reason was she was stunned with surprise, just based on the sense that I can't imagine the dress was really that restrictive).
I would guess the claim afterwards that she couldn't was rationalization, and that the real reason was she was stunned with surprise, just based on the sense that I can't imagine the dress was really that restrictive
The dress was my speculation (and not that it was restrictive, but that it was buoyant under her legs). Her claim was that her legs wouldn't go down, and while I haven't tested this myself in water I think this is probably right: you need to bend your legs to get them under you, and she was keeping them straight due to inexperience with water.
That's true and a very important point I wish I had included. I assumed consciousness and some unstated degree of able-bodiedness. A good hit to the head on the way in and/or certain physical limitations, and mere inches of depth will be the determinant.
Maybe even a net positive for her and the family on future water safety.
I don't think so: this could easily have happened when no one was attentive and that would have been a disaster.
I interpreted "net positive" as 'net positive given the actual (non-disastrous) outcome', rather than net positive ex ante.
Regardless, thanks for the OP. I only have niblings, not kids of my own, and I'm by nature pretty cautious anyway -- but I sometimes struggle to judge which of my fears to take seriously and which ones to chill out about. Your story gave me a useful jolt and made sure I keep water safety in the "justified paranoia" column!
Are child swim lessons common in America? Over here, free swim lessons are now provided for children, and mandatory swim lessons are provided as part of primary school. My understanding is that it's made a relatively large dent in the rate of child drowning injury.
In particular, once your child is proficient at swimming, you can get lessons on plain clothes swimming incase of a trip, fall, or if another kid needs rescuing.
Like many things in America, swim lesson accessibility is unevenly distributed. Larger municipalities do often offer low-cost swim lessons but these fill up quickly. Private swim lessons can be quite expensive. And sadly, swim lessons are not a standard part of public education. Local and regional variation is the name of the game. Even at the high school level, not every school will have its own pool.
In regions of the US that have a lot of open water (natural bodies or just hot places where lots of people have swimming pools), it's pretty common to start basic floating lessons in infancy, because you never know when a kid might accidentally fall into the water.
In other regions it's a lot less so.
Are child swim lessons common in America? Over here, free swim lessons are now provided for children, and mandatory swim lessons are provided as part of primary school.
It sounds like maybe you're talking about somewhat older kids; is it common for kids in your country to have taken swim lessons by age four?
is it common for kids in your country to have taken swim lessons by age four?
I'm not the original commenter, but here in Australia it's pretty common. This report bemoaning the decline(!) in swimming skills claims that 59% of kids are enrolled in formal swimming lessons by the age of 3.
(The linked page says "before age three", but the full report says both "before the age of three" and "between 0-3 years old", which I would usually take to include the year before the child turns 4. So I'm not sure what the cutoff is. And I don't know if the statistic is well supported; I'm only using it to back up the vague claim that swimming lessons for kids under 4 are pretty common here.)
Apologies for the late reply.
With a bit over 600k 0-3 year Olds in swim lessons at the time of the linked report, and around 1.2 million children in that age range in Australia, I'd estimate at least half of kids below 4 have taken swim lessons. So quite common, but not to the extent that I had thought.
Notably, swim lessons for young children are highly subsidized by most states, with many offering a fixed number of free lessons.
A bit later in primary school, the majority of kids will be given free swim lessons at their local public pool though.
I was going to say that you should still have the kid checked due to "secondary drowning", but apparently that's largely a myth: https://www.redcross.org/take-a-class/resources/articles/dry-or-delayed-secondary-drowning According to the Red Cross, there's no record of anyone nearly drowning, completely returning to normal, and then dying afterwards. If the person had shown symptoms like confusion or coughing, they'd be at risk for later dying despite rescue, but not if they completely and quickly recovered after the incident.
I was taught to 'swim' and comfortable with holding my breath and getting to the side of a pool and back-floating all before the age of 1.
One of the closest times I came to drowning was at age 4, when I was playing with a half-full bucket of water and fell in. I held my breath and wiggled my legs to tip the bucket over, and was fine. But had I not held my breath and instead inhaled water, I probably would not have been fine.
Can she swim? 'Cause that's the immediate solution for this kind of problem that came to mind. But if she can already swim, then that means swimming ability wouldn't have saved her, or other kids in similar situations.
After she recovered she told me she was trying to push her legs down and stand up, but they wouldn't go down.
I see an electrical cord going into that fountain (I assume for the pump), and I would like to point out a hidden danger which might or might not have played a role here. Faulty electrical wiring in water (such as a pool or a fountain) can cause current to flow through the body of a person in the water, leading to muscle contraction / paralysis. If the leakage current is large enough, it can directly kill; but even if it's fairly small, the resulting paralysis can cause drowning, due to the inability to right oneself or exit the water.
The reason I'm not sure this was the cause here, is that you didn't describe any sensation of shock when reaching into the water. However, it's possible that you were wearing well-insulated shoes, or that you just didn't notice the sensation because of adrenaline.
According to https://en.wikipedia.org/wiki/Electric_shock_drowning it's apparently most common with malfunctioning electrical systems on boats/piers; but it does occasionally happen in fountains or pools. It can result in a very tragic problem that also sometimes happens with confined space / toxic atmosphere rescues; the would-be rescuers (not perceiving the danger) end up as additional victims.
Because of this, I tend to be very careful about entering pools / hot tubs whose maintenance status is not known to me. (Anything electrical that's in/near water, if installed to modern code, will have a GFCI, which will trip instantly in case of leakage current.) Obviously this does not help someone who slips in by accident. I am also very nervous about any sort of electrical device that is used in water (such as the fountain pump in the picture.) If it's got 120V going into the water, the hazard is obvious; but even if the immersed cord is low-voltage, it's still likely to be one malfunction (of the power brick) away from electrifying the water to 120V, if the brick is not plugged into a GFCI. And if the fountain / the brick was obtained from Amazon, it's likely not made to American electrical safety standards.
it's possible that you were wearing well-insulated shoes
I was barefoot, but I'm also not sure shoes would be that big a component since I was fully in the water?
you just didn't notice the sensation because of adrenaline
I don't remember feeling any shock, and I think I still would have noticed?
