New research explores key factors influencing fatal and non-fatal drownings in children

Newly published research highlights key factors such as adult supervision and environment can significantly influence a child’s likeliness to survive drowning. Assistant Professor Kevin Rix, PhD, MPH, at UTHealth Houston School of Public Health in Dallas, collaborated with a team of researchers to analyze drowning incidents of children aged 0-17 at a Texas Level 1 pediatric trauma center to analyze such factors to avoid and prevent one of the highest causes of death in children.

The study, published in Injury Prevention, found three key factors, such as supervision, environment, and community risk impacted the rate of survival among children.

Children under adult supervision were significantly less likely to require hospitalization and were over six times more likely to survive a drowning incident. Notably, only 16 percent of fatal drownings occurred while the child was supervised, compared to 61 percent of non-fatal cases.

Environmental factors such as the type of water also provided insightful analysis, showing that non-fatal drownings most commonly occurred in pools (79 percent), while fatal drownings involved pools less than half the time.

The research was led by Marisa Abbe, PhD, CPSTI, director of the Injury and Violence Prevention Program at Children’s Health. Abbe emphasized the importance of understanding the circumstances surrounding traumatic injuries to develop targeted prevention strategies. "Children’s Health is the only Level 1 pediatric trauma center in North Texas, and our comprehensive injury prevention program continuously tracks data on how and why children suffer traumatic injuries in our community,” said Abbe. “Collaborating with public health experts like Dr. Rix enhances our ability to create effective interventions."

Rix highlighted the value of such collaborations, stating, "This research is critical in demonstrating how academic institutions can partner with community entities, particularly hospitals, to leverage clinical data for public health research. Working with the Injury Prevention team at Children’s Health allowed us to blend research and practical expertise, leading to new insights that can ultimately prevent pediatric drownings."

Abbe says, her team of researchers also examined community factors by correlating the patients' zip codes with the Child Opportunity Index (COI), a tool that assesses 20 indicators related to economic, educational, health, and community opportunities. Children living in communities with the lowest COI less often presented to the hospital for a drowning event, but when they did, they less often survived. This approach provided deeper insights into the social determinants of health and their connection to injury risk.

Future research should focus on current barriers some communities face in access to protective factors such as swimming lessons and life jackets, and how historical policies of exclusion from public pools in segregated communities may have impacted these research findings.

The study aims to lay the groundwork for influencing policies related to preventing drownings in children. It emphasizes the need for educational resources that address drowning prevention in various environments beyond pools, highlight the importance of supervision, and consider community-specific risk factors.

“This research begins to broaden the picture of what puts children at risk from the worst-case scenario after a drowning event,” Rix said. “In the future, we hope to use this information to better understand the specific conditions that put children at risk, and promote the best prevention practices to keep children safe around all types of water and in a variety of communities.”

Other contributors to the research include David Aguilar, Children’s Health; Jesus Alderete, Children’s Health; Alejandra Fernandez, PhD, MS, UT Southwestern; and Sarah Messiah, PhD, MPH, UT Southwestern.