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Okay, let's get started. So we have covered a
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lot of summer hazards in summer school so far.
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Fireworks, broken bones, extreme heat, bugs,
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bites. But there's one topic we've been saving,
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and it's probably the most important one we're
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going to talk about all summer. And that's drowning.
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And this is a harder episode than some of the
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others we've recorded. It is, because drowning
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isn't a hypothetical risk. It's something that
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changed families forever. And as a pediatric
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emergency physician, it's one of the things I
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worry most about every summer. Drowning is the
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leading cause of death for children ages one
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to four in the United States. And unlike a lot
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of other dangers we've talked about this summer,
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it often doesn't look dramatic. It can happen
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quickly, quietly, and with adults nearby. Which
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is why this is an episode that we really wanted
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to do. So let's get started. Welcome back to
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this week's episode of the Rolin Forward Podcast.
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I'm Dr. Alicia Rolin. And I'm Dr. Stephanie
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Rolin. I'm a pediatrician. And I'm a psychiatrist.
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We're sisters, physicians, researchers, and podcasters.
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And we started this podcast because parents are
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constantly bombarded with health information,
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some of it accurate, much of it confusing, and
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a lot of it actually quite misleading. And our
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goal is to cut through that noise and give you
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some practical evidence -based information that
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you can actually use. And this summer we're doing
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that through summer school lessons from the pediatric
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emergency room. It's a series on injuries and
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illnesses we see predictably every summer and
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what families can do to prevent them. Today's
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lesson is drowning prevention. We're going to
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talk about who is most at risk, what drowning
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actually looks like, why it can be so easy to
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miss, what flotation devices can and can't do,
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swim lessons, life jackets, and the layers of
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protection that make being around water safer
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for kids. This one is serious, but it's also
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incredibly important because drowning is preventable
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and there are concrete things every family can
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do to reduce the risk. So let's start with the
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scope of the problem because I don't think most
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families realize how significant the risk of
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drowning actually is. Drowning is currently the
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leading cause of death for children ages one
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to four in the United States. Unintentional injury
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is the leading cause of death for children age
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five to 14, led by motor vehicle accidents, and
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then drowning. So in the United States, over
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4 ,500 people die from unintentional drowning
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each year, which averages out to about 12 deaths
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daily. That's huge. It is. It truly is. But what
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we know is that nearly half of fatal unintentional
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drownings occur in the summer. And that's why
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this is part of the summer series. When most
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people picture drowning, they imagine a child
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splashing, screaming, waving their arms, yelling
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for help. And that's one of the biggest myths
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we're going to talk about today, because real
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drowning often doesn't look like drowning in
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the movies. Real drowning is quiet. A child may
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simply be struggling to keep their mouth above
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water. They may not be able to call for help
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because all of their energy is being used to
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breathe. which is terrifying. And that's one
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reason adults can be standing nearby and not
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immediately realize that something is wrong.
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So what should parents look for? You should really
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look for someone who isn't making forward progress
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in water. You can look for a child who's vertical
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in the water, but isn't moving or isn't treading
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water. And of course, someone who is motionless
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or face down in the water needs immediate help.
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But I think the larger lesson here is do not
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wait for
Load full transcript
screaming and dramatic splashing. Kids
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in the pool, they're usually loud. And if someone
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is suddenly quiet, It is time to check and make
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sure that they are okay. And when we think about
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drowning, Alicia, who's at the greatest risk?
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It's toddlers, particularly children age one
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to four. Why? They're mobile, they're curious,
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they have absolutely no fear. None. And they
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don't understand danger. No concept of danger.
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This is a perfect recipe. Many drowning incidents
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occur when a child slips away unnoticed for just
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a few minutes. And that's what makes toddler
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drowning so frightening. It doesn't take a long
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lapse in supervision. Exactly. A toddler can
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slip away incredibly quickly, even in a really
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attentive family. You answer a text, you help
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another child, you grab a towel, you assume another
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adult is watching. We've all done these small
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motions. And that's why drowning prevention can't
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rely on a parent being perfectly vigilant every
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second. We need multiple layers of protection
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so that if one layer fails, another is there.
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And here's one piece of advice we really want
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parents to remember. If all of a sudden your
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young child's missing, it happens. You should
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check the water first. The pool, a hot tub, the
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pond that abuts your property, the lake. Before
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you start searching the neighborhood or checking
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with neighbors or driving around, check the water
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first. That's really chilling, but it's very
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practical advice because drowning can happen
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so quickly that every second matters. How quickly
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does this happen? It's much faster than most
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people realize. We're often talking about seconds
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to a few minutes, not even necessarily long enough
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for another adult to notice that something is
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wrong. And that's one reason that drowning is
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so frightening. It could just happen so quickly
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and quietly. Let's say a child does go underwater
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and then is found and rescued. Are they okay?
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Not necessarily. And this is where things get
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a little more nuanced. If a child has a significant
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water aspiration event, meaning they inhaled
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water, had persistent coughing, or appeared to
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be struggling in the water. The effects aren't
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always immediately obvious. So just because a
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child looks okay immediately afterwards doesn't
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mean that the story is over. Sometimes breathing
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problems can develop over the next several hours
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as the lung becomes irritated or injured. And
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that brings us to one of my least favorite topics
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on the internet. Let me guess. Is it dry drowning?
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Dry drowning! What is this? It's where social
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media takes a real medical concept and turns
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it into something much scarier than it needs
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to be. Because we did just talk about how symptoms
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can develop later. Right. After a significant
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water aspiration event, some children can develop
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breathing problems over the next several hours.
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That is real. What is not real is that a child
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can go swimming, seem completely normal for days,
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and then suddenly die from dry drowning in their
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sleep days later. There's no recognized medical
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diagnosis called dry drowning or secondary drowning.
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So what should parents actually be watching for?
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If your child had a significant water event,
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they likely need to be evaluated and observed
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by a medical professional for at least six to
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eight hours. But if your home thinks to look
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for include persistent coughing, trouble breathing,
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unusual sleepiness, confusion, or just worsening
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of their symptoms. But if your child went swimming,
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like mine did today, was totally fine during
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the swimming, felt fine afterwards, remained
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completely well, and is running around normally
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days later, they are not secretly drowning. They
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are not secretly drowning. All right, some more
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drowning questions. As an
emergency pediatrician,
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when you think about drowning, are all bodies
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of water equally dangerous? This is one of the
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things that surprise parents the most. Most people
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hear drowning and they picture the ocean. They
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picture the big waves, the rip currents, and
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these dramatic rescues. So basically Baywatch.
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Exactly. But for young children, the highest
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risk body of water is often the one that's right
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in your backyard. The pool? The pool. Because
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pools are accessible, they're familiar, they're
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close to home. Many drowning incidents happen
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during everyday moments. A barbecue, a birthday
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party, a family gathering, an afternoon swim.
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It's not necessarily during some dramatic vacation
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accident. Which is actually much scarier. It
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is because familiarity lowers our guard. Parents
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are often appropriately cautious at the beach.
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They might be less cautious around a pool that
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they've seen hundreds of times that their child
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has been in hundreds of times. And what about
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lakes? Lakes have their own challenges, poor
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visibility, drop -offs, docks and boats, and
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currents that people don't always appreciate.
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And unlike a pool, you often can't see what's
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underneath the surface. And then, the ocean.
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The ocean adds the complications of rip currents,
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waves, undertows, and changing conditions. But
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the good news is that people often recognize
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the ocean as dangerous and behave accordingly.
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So the takeaway isn't that pools are more dangerous
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than oceans. It's that parents should be just
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as vigilant around the backyard pool as they
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are at the beach. Water is water, and it needs
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to be respected the same everywhere. And speaking
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about lakes, let's talk about boats, life jackets,
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because some families own life jackets, but not
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every child wears one. As a pediatric emergency
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physician, this is one of the easiest safety
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recommendations I'll ever make. If your child
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is around a natural body of water, lakes, rivers,
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boating, kayaking, paddleboarding, jet skis,
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I strongly recommend a U .S. Coast Guard approved
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life jacket. But what if they know how to swim?
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Especially if they know how to swim. Because
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accidents don't just happen to non -swimmers.
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People get tired, boats capsize, kids get knocked
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into the water unexpectedly. Strong swimmers
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can panic. You can be in an area of water that's
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unsafe. So now this isn't just about toddlers
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anymore. Not at all. Life jackets save lives
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across all age groups. You seem to have some
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pretty strong feelings about this. I do because
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every summer I see families spend hundreds of
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dollars on boats and paddle boards and lake vacations
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and then decide that the $5 life jacket rental
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is optional. And that's exactly backwards. So
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if there's one thing that parents remember? Around
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natural water, wear a life jacket. Okay. Now,
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now let's have some fun. Let's start a fight.
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You ready? I'm ready. Parents love floaties.
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They love them. They're so great. Thoughts? I
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completely understand why. They make kids happy.
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They make parents feel safer. They often allow
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kids to spend more time in the water. But the
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concern is that they create a false sense of
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security. Meaning? Parents sometimes look at
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children wearing floaties and think, great. they
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are going to be safe in the water. But floaties
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are toys. They're not safety devices. They can
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slip off. They can deflate. They can fail. And
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they don't eliminate the need for supervision.
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But what about those really cute pedal jumpers?
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They're certainly better than inflatable arm
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floaties, but they still carry the same risk.
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It creates a false sense of security for both
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kids and parents. It can lead parents to relax
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supervision and give this kid sense that they
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know how to float and swim when they absolutely
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cannot. They also can encourage a vertical body
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position, which some experts worry that this
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may delay the development of independent swimming.
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Meaning? That they keep kids in this very vertical
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upright position in the water. They teach, to
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swim, to float, you have to stay upright and
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kick. But swimming actually requires a horizontal
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body position. And so some instructors worry
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that puddle jumpers can delay the development
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of proper positioning and understanding of how
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to swim. So the issue isn't just whether they
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float. That's correct. It's also about what habits
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they're teaching kids. And what's the biggest
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mistake that parents make with floaties? Thinking
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that a flotation device has replaced supervision.
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A child wearing floaties can still drown. A child
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wearing a puddle jumper can still drown. Does
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that mean that parents should throw these away?
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No, and that's not my message. My message is
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to understand exactly what they're for. They're
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pool toys. They're not a substitute for swim
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lessons. They're not a substitute for supervision
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or life jackets. You just mentioned swim lessons.
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Do swim lessons help? Absolutely. The evidence
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suggests swim lessons reduces drowning risk.
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At what age? The American Academy of Pediatrics
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says swim lessons can begin for many children
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around 12 months of age, depending on readiness.
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But they're only one layer of protection. What
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about for younger babies, like the mommy and
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me or papa and me classes where you hold the
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baby and you sing the song and you go, bop, goes
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the weasel and then they go underwater? You know?
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No, no, you don't know? I know. It's very specific.
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Those can be really wonderful. And parents sometimes
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hear that the AAP says swim lessons shouldn't
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start before age one, and they assume that these
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infant mommy and me classes have no value. And
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that's not true. For babies, the goal isn't teaching
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independent swimming. There's no evidence that
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infant swim lessons before age one reduces drowning
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incidence. Its goal is to help children become
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more comfortable in the water. and helping parents
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learn water safety skills and making water a
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positive experience so that your one -year -old
00:12:45.669 --> 00:12:47.330
doesn't go in the pool for the first time and
00:12:47.330 --> 00:12:50.710
scream their face off. Plus, it can be fun. But
00:12:50.710 --> 00:12:52.929
there's no evidence that these classes reduce
00:12:52.929 --> 00:12:55.710
drowning, not even those infant swim rescue ones?
00:12:56.250 --> 00:12:57.990
No, and that's a really important distinction.
00:12:58.269 --> 00:13:00.250
You've probably seen videos of very young babies
00:13:00.250 --> 00:13:02.149
being taught to roll onto their back and float
00:13:02.149 --> 00:13:04.490
face up. Babies can actually be trained to do
00:13:04.490 --> 00:13:06.889
that reflexively, but the American Academy of
00:13:06.889 --> 00:13:09.549
Pediatrics says that this ability has not been
00:13:09.549 --> 00:13:12.629
shown to reduce infant drowning rates. But there
00:13:12.629 --> 00:13:14.570
are very polarized views on lines, with some
00:13:14.570 --> 00:13:16.330
parents crediting the survival training with
00:13:16.330 --> 00:13:18.549
life -saving skills, and while others worry about
00:13:18.549 --> 00:13:20.909
high stress crying, a potential water trauma
00:13:20.909 --> 00:13:23.210
during these intense conditionings. So it sounds
00:13:23.210 --> 00:13:25.610
like maybe babies could learn this floating response,
00:13:25.669 --> 00:13:27.590
but there's no evidence that this would actually
00:13:27.590 --> 00:13:30.570
prevent drowning. Exactly. Babies under a year
00:13:30.570 --> 00:13:32.950
aren't developmentally capable of the coordinated
00:13:32.950 --> 00:13:36.970
movements for true survival swimming. The AAP's
00:13:36.970 --> 00:13:38.940
latest guidance that came out this summer says
00:13:38.940 --> 00:13:40.659
that they're not yet able to coordinate their
00:13:40.659 --> 00:13:42.639
arms and legs to propel themselves and perform
00:13:42.639 --> 00:13:44.779
most of the motor skills required for survival
00:13:44.779 --> 00:13:47.299
swimming. They also raise a concern about programs
00:13:47.299 --> 00:13:49.440
that use repeated submersions to teach the back
00:13:49.440 --> 00:13:51.539
float response. Repeated submersions can create
00:13:51.539 --> 00:13:53.580
this negative experience with the water, and
00:13:53.580 --> 00:13:56.000
that might interfere with later swimming competency.
00:13:57.059 --> 00:13:59.480
So my child's now a year old. They're actually
00:13:59.480 -->
00:14:01.820
three years old. We've been doing swim lessons
00:14:01.820 --> 00:14:05.759
regularly. Has this eliminated drowning risk?
00:14:06.179 --> 00:14:08.889
No. There's a statement in pediatrics, and it's
00:14:08.889 --> 00:14:10.970
that the biggest risk factor for drowning is
00:14:10.970 --> 00:14:12.830
not knowing how to swim, and the second biggest
00:14:12.830 --> 00:14:15.649
risk factor is knowing how to swim. There's no
00:14:15.649 --> 00:14:17.690
winning here. There's no winning. If you know
00:14:17.690 --> 00:14:19.669
how to swim, you're more comfortable around water.
00:14:20.029 --> 00:14:21.690
There's sometimes a little bit more lack of supervision.
00:14:22.269 --> 00:14:24.110
If you don't know how to swim, you don't know
00:14:24.110 --> 00:14:26.830
how to swim. So a child who's had swim lessons
00:14:26.830 --> 00:14:29.129
can drown. A child who's a strong swimmer can
00:14:29.129 --> 00:14:32.129
drown. Adults can drown. Lifeguards can drown.
00:14:32.730 --> 00:14:34.509
Swimming ability lowers the risk of drowning,
00:14:34.649 --> 00:14:37.610
but it does not eliminate the risk. So, let's
00:14:37.610 --> 00:14:40.309
talk about supervision. Because every parent
00:14:40.309 --> 00:14:43.029
thinks that they're supervising. I'm always supervising.
00:14:43.350 --> 00:14:45.129
This is where I introduce one of my favorite
00:14:45.129 --> 00:14:49.889
concepts, the water watcher. Superhero water
00:14:49.889 --> 00:14:52.750
watcher! The idea is that one adult is specifically
00:14:52.750 --> 00:14:54.830
responsible for watching children in the water.
00:14:55.389 --> 00:14:57.129
They don't have a phone, they don't have a book,
00:14:57.309 --> 00:14:58.929
they're not drinking alcohol, they're not scrolling
00:14:58.929 --> 00:15:01.129
Instagram, and they're not assuming that someone
00:15:01.129 --> 00:15:03.940
else is watching. the designated driver, let's
00:15:03.940 --> 00:15:06.379
say, of the pool. Exactly, because one thing
00:15:06.379 --> 00:15:08.820
that we repeatedly see is groups of adults where
00:15:08.820 --> 00:15:11.620
everyone assumes someone else is paying attention,
00:15:11.879 --> 00:15:14.460
and then no one is actually paying attention.
00:15:15.200 --> 00:15:17.200
All right, so let's end with three things that
00:15:17.200 --> 00:15:20.139
parents should remember. Number one, and I think
00:15:20.139 --> 00:15:23.059
this is really important, drowning is often silent.
00:15:23.500 --> 00:15:25.740
Don't look for screaming. Look for kids that
00:15:25.740 --> 00:15:30.120
are vertical and quiet. Check. Number two, no
00:15:30.120 --> 00:15:33.659
flotation device replaces supervision. And what's
00:15:33.659 --> 00:15:36.399
number three? The most effective drowning prevention
00:15:36.399 --> 00:15:39.460
strategy is layers of protection. Having swim
00:15:39.460 --> 00:15:42.879
lessons, having a fence around the pool, always
00:15:42.879 --> 00:15:45.700
having adult supervision, wearing life jackets,
00:15:46.299 --> 00:15:49.120
having designated water watchers. So it's not
00:15:49.120 --> 00:15:52.159
one thing, it's multiple things working together.
00:15:53.279 --> 00:15:55.940
This is really important because drowning isn't
00:15:55.940 --> 00:15:58.320
something that happens to careless families.
00:15:58.879 --> 00:16:01.879
It happens to loving families, attentive families,
00:16:02.419 --> 00:16:05.399
good parents. And drowning prevention, it cannot
00:16:05.399 --> 00:16:08.720
depend on being perfectly vigilant every second.
00:16:08.899 --> 00:16:11.100
So it's using these tips to build these layers
00:16:11.100 --> 00:16:14.360
of protection so that when one layer fails, because
00:16:14.360 --> 00:16:16.620
it will, there's another layer of protection
00:16:16.620 --> 00:16:19.639
there to step in. And if our episode today felt
00:16:19.639 --> 00:16:21.440
a little heavier than our usual summer school
00:16:21.440 --> 00:16:23.950
lessons, That's because this is one of the topics
00:16:23.950 --> 00:16:26.649
where the stakes are really that high. And the
00:16:26.649 --> 00:16:28.809
reason that we talk about it isn't to make families
00:16:28.809 --> 00:16:31.950
afraid of the water. Kids should swim. They should
00:16:31.950 --> 00:16:33.929
go to the lake. They should go to the neighborhood
00:16:33.929 --> 00:16:36.090
pool and have a pool party and spend their summer
00:16:36.090 --> 00:16:38.850
outside. We just want them to do those things
00:16:38.850 --> 00:16:41.509
as safely as possible. And the statistics around
00:16:41.509 --> 00:16:43.909
drowning, they're scary. They're really scary.
00:16:49.579 --> 00:16:52.000
So, thank you for listening to this week's episode
00:16:52.000 --> 00:16:54.679
of the Rolin Forward podcast. I'm Dr. Alicia
00:16:54.679 --> 00:16:57.840
Rolin. I'm Dr. Stephanie Rolin. If you liked
00:16:57.840 --> 00:16:59.899
our episode today, please be sure to follow,
00:17:00.039 --> 00:17:02.399
like, and subscribe. Share it with a friend,
00:17:02.399 --> 00:17:04.480
and then we'll see you next week for another
00:17:04.480 --> 00:17:11.380
episode of Summer School. I'm a pediatrician.
00:17:11.640 --> 00:17:14.119
I'm a forensic psychiatrist. Well, then I'm a
00:17:14.119 --> 00:17:16.319
pediatric emergency physician. Well, I don't
00:17:16.319 --> 00:17:17.460
know. I don't know.