“Drowning is the number 1 cause of death in 1- to 4-year-olds and the number 3 cause of death in 5- to 18-year-olds,” says Dr. Kathy Monroe, medical director of Children’s of Alabama Emergency Department. “We worry about cancer and diseases, but drowning is actually more common than people think.”

Strategies to prevent child drowning are needed, Dr. Monroe says, but remember that drowning can be easy to miss.

“Children don’t scream or yell, ‘Help!’” she says. “They flail. They’re usually found face down in the water. No one sees.”

Dr. Kathy Monroe

Top 3 Tips to Prevent Child Drowning

Take an Infant CPR class

As soon as you know you’re having a child (or if you have children in your life), you should take a CPR class. Dr. Monroe says this is the best way to protect your child.

Insist your children wear life jackets

Anytime children are near water—whether on a boat or simply spending time on a dock or pier—they need to wear a properly fitting life jacket that is approved by the U.S. Coast Guard (life vest for infants, life vest for toddlers, life vest for bigger kids). Other inflatable devices are not reliable, according to Dr. Monroe.

Enroll your children in swim lessons

The American Academy of Pediatrics (AAP) “recommends swim lessons as a layer of protection against drowning that can begin for many children starting at age 1” and calls swim lessons “a must for most families” who have children aged 4 and up. By 4, most children can learn basic survival skills, including treading water, floating, and accessing an exit point.

However, Dr. Monroe cautions parents not to treat swimming ability as a failsafe solution. “Children 4 and under still need to stay in arm’s reach,” she says. “People can panic in the water.”

Drowning Prevention Tips Around the Pool

“Pool drownings are the most common type we see,” Dr. Monroe says. Below are some ways to keep your kids safe while swimming.

Install a Safety Fence Around the Pool

According to the AAP, the most important safety feature for homes with a pool is a four-sided fence that surrounds the pool completely and separates it from the house. Dr. Monroe emphasizes the importance of choosing a solid fence (“Kids can climb chain-link fences,” she says) and a self-latching gate that young children can’t easily open.

Remove Toys and Other Items from the Pool

Dr. Monroe recommends that parents remove toys, floaties, etc. from the pool when they’re not actively using it. Leaving items floating in the pool is tempting for curious toddlers who might want to retrieve the items, she says.

Don’t Rely on Swim Floaties

Armbands, water wings, and other inflatables can offer extra buoyancy and make swimming more fun. However, they can lose air and don’t offer reliable protection. “Floaties won’t protect a child if they start to drown,” Dr. Monroe says. “Don’t have a false sense of security.”

Dr. Monroe calls pool parties “a high-risk situation.” In a large group of people, many adults may feel comfortable letting the children swim, but then suddenly people realize they can’t see one of the kids.

The number one drowning prevention tip? Designate one adult at a time as the designated pool watcher (aka lifeguard). This person must give the pool their full attention—no texting, no talking on the phone, and no daydreaming. Dr. Monroe even suggests having the pool watcher wear a lanyard so others will not try to chat. Adults can take turns so no one misses the entire party.

Drowning Prevention Tips In the Home

The best way to protect your child at home? “Have a healthy respect for standing water,” Dr. Monroe says. Here’s what to watch for and what drowning prevention tips you should incorporate with your family.

Be Careful During Bathtime

When you bathe your child or toddler, follow the golden rule: Never leave a child unattended in the tub. This is non-negotiable. Dr. Monroe suggests gathering everything you need (towel, phone, etc.) so you never have a reason to leave the room.

“You have to be hands-on with an infant,” Dr. Monroe cautions. “Even in a little infant tub, if you run out to answer the phone, baby can slip underwater, and they don’t have the muscle tone to get out.”

Use a Toilet Lock

Toddlers are curious—and most are fascinated with water. Dr. Monroe says a toddler may be interested in a toilet and stick their head in to get a look. Unfortunately, toddlers are “top-heavy” and can’t get back out. “We see toilet immersion injuries frequently,” she says.

The solution: Install a toilet lock. “They’re cheap and effective,” Dr. Monroe says. “They keep the child out while letting adults open the lid.”

Be Cautious around Ponds and Fountains

A water feature is a beautiful addition to a yard—however, for families with children, a pond or fountain can pose a real drowning risk. Dr. Monroe suggests either waiting until your children are older to install a water feature or being extremely attentive when your children are outdoors.

Watch for unlikely sources of standing water

“A child can drown in less than an inch of water,” says Dr. Monroe. For instance, a bucket in the yard collecting rainwater can be deadly for a toddler, who might stick their head in the bucket and then not be able to get it back out.

What About Dry or Secondary Drowning?

You’ve probably seen the social media posts about dry drowning and secondary drowning, but Dr. Monroe says the phenomenon people are referring to is actually fairly rare.

“Secondary drowning is not a true medical term,” Dr. Monroe says. She explains that after being submerged in water, a child can get a secondary inflammation that results in a cough that worsens over time.

“The media conveys dry drowning as a dramatic event,” she says, “but it’s actually an insidious, slow-onset situation.” If a child has a minor situation while swimming (for instance sputtering or swallowing water), you should watch them at home for the next 72 hours. Look for symptoms such as persistent coughing and difficulty breathing. “Parents know what normal breathing looks like,” Dr. Monroe says. “The ribs should not be pulling to breathe.”

If you remove your child from a pool and perform CPR, the child will usually start coughing and sputtering. At that point, Dr. Monroe says, it’s still crucial to get them to a physician for an evaluation. After submersion, there’s a 6- to 12-hour period during which they can worsen, according to Dr. Monroe.

She emphasizes the need to bring a child in for a medical assessment as well as watch them carefully—even if they seem fine.