Drowning is a medical emergency resulting from respiratory impairment caused by submersion in a liquid. The speed of response directly influences the outcome, as oxygen deprivation can lead to severe damage within minutes. Understanding the proper sequence of action is essential in a situation where every second counts. This guide details the steps to take if a child is actively drowning or has been removed from the water, but it is not a substitute for formal cardiopulmonary resuscitation (CPR) certification training.
Recognizing the Signs of Active Drowning
Drowning is often a silent event, contrary to the dramatic splashing and yelling frequently depicted in popular media. A child in distress typically cannot call for help because the respiratory system prioritizes breathing over vocalization. This quiet struggle is part of the “instinctive drowning response,” a series of involuntary physical actions.
A child experiencing this response will appear vertical in the water, with little or no supporting kick. Their arms will often be extended laterally, pressing down on the water to keep their mouth above the surface. The head may be tilted back, with the mouth open, and the eyes might appear glassy, unfocused, or closed, indicating a vacant stare. This response is brief, lasting only 20 to 60 seconds before the child begins to submerge.
Other subtle indicators include hyperventilating or gasping for air rather than taking full breaths, or a body that is floating face-down. Any child whose head is low in the water or who is trying to “climb an invisible ladder” by pushing down with their arms should be considered in distress. Prompt recognition of these non-dramatic signs is the first step toward a successful rescue.
Safe Removal from Water and Emergency Contact
Rescuer safety is paramount; a person should only enter the water if they are a trained swimmer and the environment is safe. The preferred method is a “reach or throw” rescue, using an object like a shepherd’s crook, rope, or flotation device to pull the child to safety without entering the water. Once a safe approach is confirmed, the child must be removed onto a stable surface, keeping their body in a near-horizontal position if possible.
After safely removing the child, the immediate next step is to activate emergency medical services (EMS). If another person is present, instruct them to call 911 or the local emergency number and retrieve an automated external defibrillator (AED) if one is nearby. If the rescuer is alone, a distinction applies in pediatric drowning incidents. Since the cause is primarily a lack of oxygen (hypoxia), the priority is immediate oxygenation.
The lone rescuer should provide two minutes of immediate care, including rescue breaths and chest compressions, before pausing to call EMS. If the rescuer is using a mobile phone, they should call the emergency number and place the phone on speaker to begin care immediately while communicating with the dispatcher. This “Care First” approach maximizes the chance of reversing the respiratory-driven cardiac arrest common in drowning.
Immediate Assessment and Rescue Breathing
Once the child is on a firm, flat surface, the rescuer must quickly assess responsiveness by tapping or gently shaking an older child’s shoulder and shouting, “Are you okay?” The next step is to check for normal breathing and a pulse for no more than 10 seconds. Gasping is not considered normal breathing and should be treated as absent breathing.
If the child is unresponsive and not breathing normally, the airway must be opened using the head-tilt/chin-lift maneuver. This involves placing one hand on the forehead and two fingers of the other hand under the chin, gently tilting the head back to lift the jaw and clear the airway. For an infant, the head tilt should be minimal, maintaining a neutral position to avoid closing off the smaller airway.
Because the child’s body is deprived of oxygen, the resuscitation sequence for drowning victims begins with five initial rescue breaths. The rescuer should pinch the child’s nose shut, create a tight seal over their mouth, and deliver a breath lasting one second, watching for the chest to visibly rise. If the chest does not rise, the rescuer should reposition the head and attempt the breath again before proceeding with compressions. These initial breaths immediately address the hypoxia.
Performing Chest Compressions (CPR)
Following the five initial rescue breaths, the rescuer must begin chest compressions, starting the cycle of CPR. For a child (typically one year of age to puberty), the compression technique uses the heel of one or two hands placed in the center of the chest, just below the nipple line. The compression depth should be approximately two inches, or about one-third the depth of the child’s chest.
For an infant (up to one year of age), the single rescuer uses two fingers placed on the breastbone, just below the nipple line. If two rescuers are present, the two-thumb encircling technique is used. The compression depth for an infant is about 1.5 inches, roughly one-third the depth of the chest. The compression rate for all ages is 100 to 120 compressions per minute.
The standard single-rescuer cycle ratio for pediatric CPR is 30 compressions followed by two rescue breaths. If a second trained rescuer is available, the ratio changes to 15 compressions followed by two breaths, maximizing ventilation and minimizing rescuer fatigue. Compressions must be high-quality, allowing the chest to recoil fully between each push so the heart can refill with blood. This cycle must be continued without interruption until EMS arrives, an AED is ready to use, or the child shows definitive signs of life.
Critical Post-Rescue Medical Care
Any child rescued from the water who required resuscitation, or even one who experienced significant distress, must receive medical evaluation. The term “secondary drowning” is a non-medical phrase referring to a serious complication known as delayed pulmonary edema. This condition occurs when inhaled water, even a small amount, irritates the lungs’ lining and causes fluid to leak into the air sacs.
Symptoms of this delayed injury, such as persistent coughing, difficulty breathing, lethargy, or a change in mental status, can manifest up to 24 hours after the incident. Most complications, however, become apparent within the first four to six hours. Even if a child appears to have recovered and is breathing normally after rescue, they must be transported to a hospital for observation and a thorough examination. Medical staff will monitor vital signs and lung sounds to ensure oxygen levels remain stable and to treat any developing respiratory distress.