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Drowning is one of the leading causes of accidental death in children. Some apparent drownings may be related to sudden cardiac death, in particular to unidentified channelopathies, which are known to precipitate fatal arrhythmias during swimming-related events. In this article, the authors examine the likely incidence of such events, the impact of these events on the community, the cardiac defects involved and whether realistic and reliable measures are available to identify those at risk.
In developed countries, drowning is the third leading cause of accidental childhood death with a mortality in the UK of 0.7/100 000 children <15 years.1 The death rate is higher in countries such as the USA and Australia where warmer climates lend themselves to more water exposure and higher numbers of domestic pools.1 2 Data from national agencies in the UK and Australia indicate that 40% of these drownings occur in swimming pools3 4 while reports from the USA demonstrate that 19% of drowning deaths in children occur in public pools with certified lifeguards present.5 There is less information concerning morbidity, but it is estimated that for each drowning death, there are up to four non-fatal drowning events requiring hospitalisation.1 In almost all cases, these events are considered accidental; thus, extensive efforts have been made to reduce the potential for unsupervised and unsafe exposure of young children to water. Drowning rates have consequently declined over recent years predominantly due to these preventive efforts.6 However, despite these efforts, one report has recently highlighted that up to 50% of drownings occur in 5–19-year-olds who were are least moderate swimmers.7
Numerous media reports have highlighted sudden demise in young children and adolescents during routine-monitored swimming lessons reflecting high profile cases of sudden deaths seen in athletes in various other sports. These cases …