AAP updates drowning prevention guidance

Drowning remains a leading cause of unintentional injury death in children, prompting the American Academy of Pediatrics (AAP) to release updated guidance emphasizing layered prevention strategies, swim instruction, and community-based interventions to reduce pediatric drowning deaths.^1,2

The revised policy statement, “Prevention of Drowning,” was published in the June 2026 issue of Pediatrics and updates the AAP’s 2019 guidance. The statement was developed by the AAP Council on Injury, Violence, and Poison Prevention and includes recommendations for clinicians, families, policymakers, and community organizations.

According to the policy statement, drowning is the leading cause of death among US children aged 1 to 4 years, while adolescents have the second-highest drowning fatality rates. The statement also noted that overall pediatric drowning rates declined from 1999 to 2019 before beginning to rise again. Racial, ethnic, and geographic disparities in drowning deaths have also widened.

Updated recommendations for pediatricians and families

The AAP continues to recommend multiple layers of protection because “no single method is effective in preventing all drowning.” Key prevention strategies include close adult supervision, swim instruction, life jacket use, four-sided pool fencing, and CPR training.

“Swimming can be a child’s first sport, and swim lessons can be introduced after a child turns 1,” said lead author Rohit P. Shenoi, MD, FAAP.

The policy recommends that children begin swim lessons after their first birthday because increasing mobility at that age raises the risk of unintended water access. However, the report states there is no evidence that infant swim lessons reduce drowning incidence.

“Toddlers are at the highest risk of drowning, as they can escape without notice even under the best of circumstances,” Shenoi said. “Adolescents are also especially vulnerable since they may overestimate their swimming skills, misjudge the seriousness of water hazards, or engage in risky and impulsive behaviors.”

The guidance also reinforces the importance of “close, constant, attentive, and competent” adult supervision around water. The report cited data showing that in 86% of fatal drownings among children younger than 14 years, the child had unpermitted access to water, and 80% were alone and unsupervised for an average of 16 minutes.

Recommendations for families include maintaining touch supervision for infants, toddlers, and weak swimmers; avoiding distractions such as phones while supervising children; and ensuring children wear Coast Guard-approved life jackets near water or while boating.

Addressing disparities in drowning risk

The updated policy places additional emphasis on inequities in drowning risk and swimming access. According to the report, fatal drowning rates from 2018 to 2022 were higher among Native Hawaiian/Pacific Islander and Black children and adolescents compared with White children.

The statement also described disparities in swimming competency and access to aquatic programs linked to historical segregation, limited community resources, and barriers to affordable swim instruction.

Children with autism spectrum disorder and epilepsy were identified as having an elevated drowning risk. The report noted that drowning risk is threefold higher among children and adolescents with autism spectrum disorder compared with peers without autism.

To address these concerns, the AAP encouraged pediatricians to identify children at higher risk because of medical conditions, swimming ability, or water exposure and provide tailored counseling. The policy also supports adapted aquatics programs for children with disabilities.

Role of legislation and community prevention

The policy highlighted evidence supporting public health and legislative interventions, including four-sided residential pool fencing laws, life jacket regulations, and lifeguard requirements.

“Preventing drowning is not the responsibility of families alone,” Shenoi said. “This is a team effort, and pediatricians are in an excellent position to help raise awareness with patients and community partners.”

The AAP also encouraged caregivers and adolescents to learn CPR and safe rescue techniques because early rescue and resuscitation significantly improve outcomes following drowning events.

“When drowning occurs, seconds matter,” Shenoi said. “Quick rescue and resuscitation can mean the difference between life, death, and lifelong disability. Ask your pediatrician if you are unsure of your child’s safety around water and what you can do about it.”

References

1. Shenoi RP, McCallin T, Farrell C, Yusuf S, Kendi S, Gilchrist J, Quan L, and the Council on Injury, Violence, and Poison Prevention. Prevention of Drowning: Policy Statement. Pediatrics. 2026. doi:10.1542/peds.2026-077410.
2. AAP. American Academy of Pediatrics Updates Recommendations on Drowning Prevention. AAP. Press release. May 18, 2206. Accessed May 18, 2026.