Papers

Preventing deaths by drowning in children in the United Kingdom: have we made progress in 10 years? Population based incidence study

Jo R Sibert, professor of community child health ^a, Ronan A Lyons, professor of public health ^a, Beverley A Smith, research nurse ^a, Peter Cornall, head of water and leisure ^b, Valerie Sumner, life saving support officer ^c, Maxine A Craven, research manager ^b, Alison M Kemp, senior lecturer ^a,  on behalf of the Safe Water Information Monitor Collaboration.

^a Departments of Child Health and Epidemiology Statistics and Public Health, Collaboration for Accident Prevention and Injury Control, University of Wales College of Medicine, Llandough Hospital, Penarth CF64 2XX, ^b Royal Society for Prevention of Accidents, Birmingham B5 7ST, ^c Royal Life Saving Society, Broom, Warwickshire B50 4HN

Correspondence to: J R Sibert sibert{at}cardiff.ac.uk

Detailed information on drowning in children is not routinely collected by offices of national statistics. Few studies have been carried out in the United Kingdom, and none has been done on British children abroad.

In 1988-9, two of the authors (AMK and JRS) combined information from national statistical offices, police forces (Royal Life Saving Society), and from a press cutting service (Royal Society for Prevention of Accidents) for a detailed analysis of deaths by drowning in children.^1-3 This analysis found that 149 children had drowned in the United Kingdom during 1998-9. It also identified a safety agenda, which focused on young children in garden ponds and pools and on older children swimming without supervision.

Over the past 10 years there have been initiatives on children's safety in water, particularly swimming. We obtained similar information for 1998-9 to identify changes that have occurred in 10 years and assessed whether these initiatives on safety have been successful.

	Methods and results

Top Methods and results Comment References

Deaths by drowning in children aged 0-14 years were identified in the same way in 1988-9 and 1998-9. We compared numbers of cases of drowning in the two periods by calculating the observed and expected numbers and comparing them with the expected numbers taken from the observed numbers in 1988, adjusted for the 6% increase in the child population over the 10 year period (table). We used the statistical package Confidence Interval Analysis to calculate ratios and 95% confidence intervals. We identified deaths by drowning that occurred outside the United Kingdom from the Royal Society for Prevention of Accidents' survey of press cuttings.

A total of 104 children drowned in the United Kingdom in 1998-9 compared with 149 in 1988-9; this represents a significant fall in incidence. The numbers of children drowning fell in all sites, apart from deaths in garden ponds, where the numbers rose significantly (P<0.05). The decreases in drownings in three areas (rivers, canals, and lakes; domestic pools; and the sea) were also significant. Three times more boys than girls drowned during both periods (table).

At least 14 British children drowned abroad. Twelve of these drowned while swimming on holiday in Cyprus, France, Spain, Turkey, or the United States. Most of the drownings happened in hotel or apartment pools.

Three boys with autistic spectrum disorder drowned in 1998-9, compared with 0.1 cases expected from a recent study in the United Kingdom⁴ (the observed to expected ratio was 30 (95% confidence interval 8.77, P<0.05)).

	Comment

Top Methods and results Comment References

The number of children dying from drowning in the United Kingdom has fallen over the 10 year period between 1988-9 and 1998-9. However, drownings in pools abroad and in garden ponds are a major concern, and safety organisations need to speak with holiday companies to improve the safety of children abroad. The European Union needs to be involved, and we believe that detailed data on deaths by drowning need to be collected routinely by government statistics offices in the United Kingdom.

The rise in the number of drownings in garden ponds may be due to an increase in the number of water features in gardens, perhaps as a result of popular garden programmes on television. Garden ponds remain a real threat to toddlers and should be covered or fenced. The reduction in drownings in domestic pools may be due to fewer pools being installed and used and some pools having safety fences and gates.

In the 10 years since 1998-9 there has been a focus on the supervision of activities with schoolchildren, and this is reflected by the reduction in river, lake, and canal drownings. The figures we have are small, but it does seem that children with autistic spectrum disorder may be at increased risk of drowning. This would coincide with their patterns of behaviour and needs further research.

	Acknowledgments

We thank the Office for National Statistics (England and Wales), the Scottish Government Record Office, and the Northern Ireland Office for their invaluable help. This study was considered as Audit by the multi-centre research ethics committee for Wales.

Contributors: AMK and JRS undertook the study in 1988-9. JRS, AMK, MAC, PC, and VS planned the study and set up the SWIM Collaboration. JRS, BAS, MAC, PC, VS, and RAL analysed the data. JRS, RAL, BAS, and AMK wrote the paper. JRS is the guarantor.

	Footnotes

Editorial by Brenner

Funding: No specific funding.

Competing interests: None declared.

	References

Top Methods and results Comment References

1.	Kemp AM, Sibert JR. Outcome for children who nearly drown: a British Isles study. BMJ 1991; 302: 931-933.
2.	Kemp AM, Sibert JR. Drowning and near drowning in children in the United Kingdom: lessons for prevention. BMJ 1992; 304: 1143-1146.
3.	Kemp A, Sibert JR. Epilepsy and the risk of drowning. Arch Dis Child 1993; 68: 684-685[Abstract].
4.	Webb EV, Lobo S, Hervas A, Scourfield J, Fraser WI. The changing prevalence of autistic disorder in a Welsh health district. Dev Med Child Neurol 1997; 39: 150-152[Medline].

(Accepted 13 September 2001)