Spanish Association of Paediatrics
Recommendations for the prevention of drowning
Recomendaciones sobre la prevención de ahogamientos
B. Rubioa,
, F. Yagüeb, M.T. Benítezc, M.J. Esparzad, J.C. Gonzáleze, F. Sánchezf, J.J. Vilag, S. Mintegih, Comité de Seguridad y Prevención de Lesiones No Intencionadas en la Infancia de la Asociación Española de Pediatría
Corresponding author
a Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
b Servicio de Pediatría, Hospital de Son Espases, Palma de Mallorca, Islas Baleares, Spain
c Instituto de Salud Pública del Ayuntamiento de Madrid, Madrid, Spain
d Atención Primaria, Centro de Salud Barcelona, Móstoles, Madrid, Spain
e Dirección General de Tráfico, Madrid, Spain
f Atención Primaria, Distrito Almería, Almería, Spain
g Servicio Cirugía Pediátrica, Hospital Infantil La Fe, Valencia, Spain
h Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Bilbao, Spain
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"apellidos" => "Mintegi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:1 [ "colaborador" => "Comité de Seguridad y Prevención de Lesiones No Intencionadas en la Infancia de la Asociación Española de Pediatría" ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital de Son Espases, Palma de Mallorca, Islas Baleares, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Salud Pública del Ayuntamiento de Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Atención Primaria, Centro de Salud Barcelona, Móstoles, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Dirección General de Tráfico, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Atención Primaria, Distrito Almería, Almería, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio Cirugía Pediátrica, Hospital Infantil La Fe, Valencia, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Bilbao, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones sobre la prevención de ahogamientos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Water is an essential element in our lives and for most children it is also a place to practise sports and an important source of pleasure and fun. Whether on a recreational basis or for competitive purposes, contact with water begins at an increasingly early age and in more and more varied settings (in public or private swimming pool facilities, waterparks, spas, in the sea, rivers or lakes).</p><p id="par0010" class="elsevierStylePara elsevierViewall">The WHO defines drowning as the process of experiencing respiratory impairment from submersion/immersion in liquid, with outcomes classified as death, morbidity and no morbidity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Over 5000 children die from drowning every year in the group of countries that make up the WHO's European region. Drowning is the second leading cause of accidental death in people aged between 0 and 19 in Europe as a whole.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain, weather conditions allow an extended period of contact with water, thereby increasing the risk due to greater exposure. Drowning accounts for 13% of the main causes of injury death in children (aged 0–14) and occupies the thirteenth place in Europe. It is also the second leading cause of accidental death, after traffic accidents, and claims around 450 lives a year among people of all ages (461 mortalities in 2011, of which 23 were under 15, and 438 in 2012, 28 of them under 15).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The statistics only reflect the number of deaths, which are the tip of the iceberg, since for every person killed there will be many other injuries that will require visits to accident and emergency departments or hospital admissions and will cause suffering and sequelae that may result in severe permanent disabilities.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Diving head-first causes over 70% of all spinal cord injuries related to sports and recreational activities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Death rates from drowning vary according to age and sex, the groups most at risk being small children and adolescent males.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7–9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Socioeconomic status and poverty are also linked to a higher risk of drowning in children.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the case of small children, it can happen in as little as 2<span class="elsevierStyleHsp" style=""></span>cm of water in the bottom of a bucket, a bath, a paddling pool or a well.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Drowning incidents in children under 5 occur mostly in swimming pools belonging to private homes or communities, where it has been shown that deaths by drowning can be reduced by up to 95% with simple regulated fencing like the one currently used for community pools.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the case of older children, drownings usually take place in lakes, the sea, rivers and canals, where recreational aquatic activities are practised. At these ages, the consumption of alcohol and drugs are added risks to adolescent impulsiveness. As many as 25% of deaths by drowning were associated with alcohol consumption.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Another type of injury is related to drain entrapment that occurs when a child is held by the forces created by water passing though the underwater drain at the bottom of a swimming pool.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These forces produce injuries to various parts of the body: hair entanglement (the most common), suction of the chest, abdomen (most often perianal and gluteal) or a limb (usually due to the absence of drain covers), evisceration of bowel loops of varying degrees of severity and death by drowning due to suction and immobilisation at the bottom of the pool.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Strategies that have proved to be effective for the prevention of drownings</span><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Supervision and surveillance</span> of any child in proximity to any aquatic environment, including swimming pools, baths, beaches, buckets containing water, etc., is an essential strategy for the prevention of drownings.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,11</span></a> Proper supervision implies that the distance to the child is less than the length of the caregiver's arm; in other words, literally keeping children within arm's reach.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The presence of a lifeguard</span> is the best way to avoid water accidents that end in drowning. However, a lifeguard cannot supervise all bathers at the same time, and it is therefore essential to <span class="elsevierStyleItalic">keep children under constant surveillance</span>. Although deaths are infrequent when there is a lifeguard present, they can happen.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">With respect to swimming pools:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Complete fencing</span> of pools around their entire perimeter, so that the pool is totally isolated from the garden and the house, is effective in preventing many drownings of children in pools.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,8,10,13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">–</span><p id="par0085" class="elsevierStylePara elsevierViewall">The fencing must enclose the entire perimeter of the pool, it must be high enough to prevent children from climbing or jumping over it, and the distance between the bottom edge of the fence and the ground must be less than 10<span class="elsevierStyleHsp" style=""></span>cm to avoid children squeezing underneath it. The gate is the most important component of the fence. It must be self-latching and self-closing and the latch must be out of the reach of children (at a height of at least 1.34<span class="elsevierStyleHsp" style=""></span>m from the ground). The fencing must never block the view of the pool.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">–</span><p id="par0090" class="elsevierStylePara elsevierViewall">If pool covers are used, they must be rigid and cover the whole length and breadth of the pool to prevent children from walking across them or slipping in at the sides of the pool and being trapped under the cover and unable to get out.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">–</span><p id="par0095" class="elsevierStylePara elsevierViewall">The depth of the pool must be indicated at the sides.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">–</span><p id="par0100" class="elsevierStylePara elsevierViewall">Diving must be prohibited if the depth is less than 1.20<span class="elsevierStyleHsp" style=""></span>m and permitted only if the water is over 1.80<span class="elsevierStyleHsp" style=""></span>m deep. However, children should be advised to jump into the pool feet first.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">–</span><p id="par0105" class="elsevierStylePara elsevierViewall">Children's pools or paddling pools must also be fenced off to prevent children having access to them on their own. If they are recreational or multipurpose pools they must include arrangements to prevent collisions.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">–</span><p id="par0110" class="elsevierStylePara elsevierViewall">The drains of both public and private swimming pools, including jacuzzis, must have safety devices to prevent suction and hair entanglement or entrapment of other parts of the body (drain covers or any other anti-entrapment mechanism).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">–</span><p id="par0115" class="elsevierStylePara elsevierViewall">If pool alarms are used (alarms in the pool to detect movement, infrared perimeter alarms, etc.), both owners and other users must be familiar with how to operate them correctly. Alarms are insufficient if they are used as the only preventive measure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">–</span><p id="par0120" class="elsevierStylePara elsevierViewall">Swimming lessons and learning water survival skills can reduce rates of drowning in children. It is advisable for children to learn to swim, particularly from the age of 4. However, the decision on when a child should begin such lessons must be made on an individual basis. There are studies that maintain that beginning lessons between the ages of 1 and 4 reduces drowning rates. Parents must take into account the frequency of the child's exposure to water emotional maturity, physical limitations and other health concerns, such as hypothermia, infectious illnesses, lung damage from pool chemicals, etc. Parents have to be aware that swimming lessons for small children small children or those who have not acquired sufficient skills will not prevent drowning or provide complete protection, and that constant supervision must therefore be maintained. Knowing how to swim well in a swimming pool does not necessarily make a child safe in natural water environments, so children should never swim without adult supervision.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">–</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The use of personal flotation devices</span> (<span class="elsevierStyleItalic">PFDs</span>) when riding in any kind of recreational watercraft is an important preventive measure against drownings. In a study of boating-related deaths carried out in the United States, 86% of those who died were not wearing a flotation device, whereas the remaining 14%, who were wearing one, died from other causes, such as hypothermia.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Children should not wear air-filled swimming aids that can be deflated (such as armbands or water wings) as these represent a risk. Life jackets are preferable.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">–</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Training in CPR procedures</span>, for parents adolescents and older children, <span class="elsevierStyleItalic">is also an effective measure</span>. Appropriate cervical protection, the time elapsed since drowning and prompt application of CPR by trained personnel are crucial for improving the prognosis in a drowning.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li></ul></p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Recommendations of the Committee on Safety and Injury Prevention in childhood</span><p id="par0135" class="elsevierStylePara elsevierViewall">Paediatricians must alert parents to the dangers that water presents at different ages and in different situations, and must therefore:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">–</span><p id="par0140" class="elsevierStylePara elsevierViewall">Advise parents and caregivers that on no account can a child be left alone or in the care of another child while in the bath, in swimming pools or spas, or near any irrigation ditches.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">–</span><p id="par0145" class="elsevierStylePara elsevierViewall">Recommend emptying water from any container after use, such as mop buckets, or any other container.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">–</span><p id="par0150" class="elsevierStylePara elsevierViewall">Warn parents that infant bath seats can never be regarded as a substitute for adult supervision, since children can slip out of them.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">–</span><p id="par0155" class="elsevierStylePara elsevierViewall">Remind them that to prevent drowning in toilets, small children should not be left alone and unsupervised in the bathroom.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">–</span><p id="par0160" class="elsevierStylePara elsevierViewall">Warn them that whenever infants or toddlers are in or around water, whether a swimming pool or any open body of water (lakes, sea, rivers, etc.), they must be within arm's reach and supervised by an adult with swimming skills. In the case of older children that can swim, the adult with swimming skills or a lifeguard must supervise them, keeping them constantly in sight, with his or her attention focused at all times on the child or children in the water, avoiding potentially distracting situations such as talking on the telephone, socialising, etc.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">–</span><p id="par0165" class="elsevierStylePara elsevierViewall">Remind them that in an emergency the supervising adult must know how to swim, perform a rescue, initiate CPR and call for help.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">–</span><p id="par0170" class="elsevierStylePara elsevierViewall">Identify families who live in residential areas with swimming pools and offer periodic drowning-prevention counselling. Recommend that any family swimming pool should be equipped with safety devices: protective fencing, alarms in the pool to detect movement, an infrared perimeter alarm and a rigid cover or structure that will bear the weight of an adult without collapsing, among others.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">–</span><p id="par0175" class="elsevierStylePara elsevierViewall">Ask specifically about portable or above-ground pools, because they are usually unfenced.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">–</span><p id="par0180" class="elsevierStylePara elsevierViewall">Remind parents that swimming lessons do not guarantee prevention of drowning but are just one more strategy in a multi-faceted approach that also includes effective fencing, appropriate adult supervision and experience in CPR.</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">–</span><p id="par0185" class="elsevierStylePara elsevierViewall">Advise parents that they should teach their children never to swim without adult supervision.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">–</span><p id="par0190" class="elsevierStylePara elsevierViewall">Recommend that whenever children are riding in any kind of watercraft or practising water sports (even if they can swim), they should wear a personal/individual flotation device (PFD), such as a life jacket.</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">–</span><p id="par0195" class="elsevierStylePara elsevierViewall">Air-filled swimming aids are not to be recommended. Furthermore, small children and any non-swimming minors should wear a life jacket whenever they are at the water's edge (by a river, the sea, a lake or on a dock or pier, etc.).</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">–</span><p id="par0200" class="elsevierStylePara elsevierViewall">Inform parents and children that jumping or diving into water can result in serious injury. Parents should know the depth of the water before allowing children to jump in. In any case, children should be advised to enter the water feet first.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">–</span><p id="par0205" class="elsevierStylePara elsevierViewall">Remind parents that in open bodies of water they should choose areas supervised by lifeguards.</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">–</span><p id="par0210" class="elsevierStylePara elsevierViewall">Warn adolescents about the risk involved in consuming alcohol or drugs while swimming or practising any other water sports activity.</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">–</span><p id="par0215" class="elsevierStylePara elsevierViewall">Advise parents that children who suffer epileptic seizures should be supervised when swimming or taking a bath.</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">–</span><p id="par0220" class="elsevierStylePara elsevierViewall">Recommend to parents that they should never lower their level of vigilance towards their children, despite the safety measures adopted.</p></li></ul></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Interventions at national level</span><p id="par0225" class="elsevierStylePara elsevierViewall">Current legislation on swimming pools in Spain has remained almost unchanged since the Ministerial Order of 31 May 1960 issued by the former Ministerio de la Gobernación. Although it has been updated by a Royal Decree (RD 742/2013 of 27 September 2013, establishing technical and health standards for swimming pools),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> family swimming pools, where the largest numbers of drownings are recorded, remain exempt from compliance with safety standards, which are applicable only to public pools.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Moreover, pools belonging to private communities of homeowners (where the number of drownings is currently increasing more rapidly) are not subject to standarized regulations in Spain's different regions, in terms of whether they are regarded as public or private.</p><p id="par0230" class="elsevierStylePara elsevierViewall">We on the Committee therefore consider that the actions required to improve water safety and prevent drownings should include:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">–</span><p id="par0235" class="elsevierStylePara elsevierViewall">Establishing minimum safety requirements at a national level so as to harmonise the legislation of the different regions and increase safety measures at swimming pools, making it compulsory, among other things, for both public and private pools to be completely fenced.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16–18</span></a></p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">–</span><p id="par0240" class="elsevierStylePara elsevierViewall">Developing European standards for public swimming pools, including signs to indicate the water depth, coloured edging on steps, life-saving equipment and covers on suction drains.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">–</span><p id="par0245" class="elsevierStylePara elsevierViewall">Making it obligatory to employ lifeguards who should be regularly re-certified.</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">–</span><p id="par0250" class="elsevierStylePara elsevierViewall">Establishing compulsory use of personal flotation devices/life jackets while practising any water sport or aquatic activity.</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">–</span><p id="par0255" class="elsevierStylePara elsevierViewall">Implementing the use of standardised safety signs and symbols (such as diving not permitted, a red flag indicating that bathing is prohibited, etc.) in all aquatic environments.</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">–</span><p id="par0260" class="elsevierStylePara elsevierViewall">At public beaches and swimming pools appropriate and sufficient information should be provided regarding preventive safety measures and include situations that could pose a health risk, on prevention of drowning and of other injuries, such as traumatic brain injuries and spinal cord injuries, among others.</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">–</span><p id="par0265" class="elsevierStylePara elsevierViewall">Information should also include the location of the lifeguard, as of the first-aid post and the addresses and telephone numbers of the nearest health care centres and accident and emergency departments.</p></li></ul></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0270" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres407957" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec384186" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres407958" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec384187" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Epidemiology" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Strategies that have proved to be effective for the prevention of drownings" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Recommendations of the Committee on Safety and Injury Prevention in childhood" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Interventions at national level" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-06" "fechaAceptado" => "2014-06-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec384186" "palabras" => array:3 [ 0 => "Drowning" 1 => "Prevention" 2 => "Childhood" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec384187" "palabras" => array:3 [ 0 => "Ahogamiento" 1 => "Prevención" 2 => "Infancia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Drowning is the second leading cause of non-intentional death in children under the age of 19 in Europe. Weather conditions in Spain allow an extended period of contact with water, therefore increasing the risk of drowning (due to the increased exposure), and constitutes the second leading cause of accidental death in children less than 14 years of age. In children younger than 5 years, drowning occurs mostly in pools belonging to private homes or communities, while in older children, drowning is often linked to aquatic recreational activities in lakes, sea, rivers and canals, and at times associated with alcohol consumption.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Paediatrics provides a series of architectonic, educational and legislative recommendations to prevent such incidents.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El ahogamiento supone la segunda causa de muerte accidental en menores de 19 años en Europa. Las condiciones climáticas en España permiten un amplio periodo de contacto con el agua, aumentando el riesgo por mayor exposición y constituyendo la segunda causa de mortalidad accidental en menores de 14 años. Los ahogamientos en menores de 5 años se producen sobre todo en piscinas particulares o de comunidades privadas y, en el caso de niños mayores, suelen estar ligados a actividades acuáticas de tipo lúdico en lagos, mar, ríos y canales, y, en ocasiones, asociadas al consumo de alcohol.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En el presente artículo, el Comité de Seguridad y Prevención de Lesiones No Intencionadas en la Infancia de la Asociación Española de Pediatría proporciona una serie de recomendaciones para prevenir este tipo de lesiones, tanto arquitectónicas como educativas y legislativas.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rubio B, Yagüe F, Benítez MT, Esparza MJ, González JC, Sánchez F, et al. Recomendaciones sobre la prevención de ahogamientos. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 9 | 20 |
| 2024 October | 86 | 54 | 140 |
| 2024 September | 125 | 54 | 179 |
| 2024 August | 127 | 88 | 215 |
| 2024 July | 113 | 36 | 149 |
| 2024 June | 115 | 31 | 146 |
| 2024 May | 108 | 37 | 145 |
| 2024 April | 102 | 42 | 144 |
| 2024 March | 110 | 40 | 150 |
| 2024 February | 99 | 32 | 131 |
| 2024 January | 98 | 30 | 128 |
| 2023 December | 148 | 32 | 180 |
| 2023 November | 132 | 27 | 159 |
| 2023 October | 125 | 31 | 156 |
| 2023 September | 94 | 26 | 120 |
| 2023 August | 136 | 28 | 164 |
| 2023 July | 141 | 24 | 165 |
| 2023 June | 133 | 38 | 171 |
| 2023 May | 151 | 46 | 197 |
| 2023 April | 99 | 29 | 128 |
| 2023 March | 116 | 34 | 150 |
| 2023 February | 103 | 16 | 119 |
| 2023 January | 95 | 32 | 127 |
| 2022 December | 98 | 28 | 126 |
| 2022 November | 97 | 40 | 137 |
| 2022 October | 119 | 60 | 179 |
| 2022 September | 106 | 43 | 149 |
| 2022 August | 128 | 55 | 183 |
| 2022 July | 77 | 41 | 118 |
| 2022 June | 119 | 42 | 161 |
| 2022 May | 144 | 50 | 194 |
| 2022 April | 92 | 41 | 133 |
| 2022 March | 109 | 63 | 172 |
| 2022 February | 65 | 45 | 110 |
| 2022 January | 103 | 47 | 150 |
| 2021 December | 75 | 54 | 129 |
| 2021 November | 92 | 47 | 139 |
| 2021 October | 165 | 65 | 230 |
| 2021 September | 94 | 53 | 147 |
| 2021 August | 84 | 39 | 123 |
| 2021 July | 109 | 30 | 139 |
| 2021 June | 99 | 53 | 152 |
| 2021 May | 118 | 42 | 160 |
| 2021 April | 211 | 114 | 325 |
| 2021 March | 117 | 35 | 152 |
| 2021 February | 61 | 24 | 85 |
| 2021 January | 75 | 33 | 108 |
| 2020 December | 72 | 21 | 93 |
| 2020 November | 59 | 17 | 76 |
| 2020 October | 62 | 16 | 78 |
| 2020 September | 47 | 29 | 76 |
| 2020 August | 59 | 34 | 93 |
| 2020 July | 56 | 19 | 75 |
| 2020 June | 59 | 21 | 80 |
| 2020 May | 80 | 19 | 99 |
| 2020 April | 67 | 19 | 86 |
| 2020 March | 65 | 18 | 83 |
| 2020 February | 75 | 21 | 96 |
| 2020 January | 93 | 30 | 123 |
| 2019 December | 75 | 22 | 97 |
| 2019 November | 33 | 18 | 51 |
| 2019 October | 57 | 13 | 70 |
| 2019 September | 51 | 25 | 76 |
| 2019 August | 43 | 15 | 58 |
| 2019 July | 57 | 23 | 80 |
| 2019 June | 63 | 23 | 86 |
| 2019 May | 85 | 35 | 120 |
| 2019 April | 83 | 34 | 117 |
| 2019 March | 41 | 11 | 52 |
| 2019 February | 38 | 14 | 52 |
| 2019 January | 56 | 23 | 79 |
| 2018 December | 55 | 27 | 82 |
| 2018 November | 115 | 31 | 146 |
| 2018 October | 106 | 24 | 130 |
| 2018 September | 45 | 14 | 59 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 9 | 0 | 9 |
| 2018 April | 17 | 0 | 17 |
| 2018 March | 20 | 0 | 20 |
| 2018 February | 13 | 0 | 13 |
| 2018 January | 17 | 0 | 17 |
| 2017 December | 23 | 0 | 23 |
| 2017 November | 26 | 0 | 26 |
| 2017 October | 12 | 0 | 12 |
| 2017 September | 26 | 0 | 26 |
| 2017 August | 17 | 0 | 17 |
| 2017 July | 32 | 1 | 33 |
| 2017 June | 39 | 17 | 56 |
| 2017 May | 30 | 9 | 39 |
| 2017 April | 111 | 13 | 124 |
| 2017 March | 24 | 8 | 32 |
| 2017 February | 15 | 3 | 18 |
| 2017 January | 19 | 2 | 21 |
| 2016 December | 29 | 11 | 40 |
| 2016 November | 48 | 6 | 54 |
| 2016 October | 43 | 8 | 51 |
| 2016 September | 48 | 9 | 57 |
| 2016 August | 52 | 7 | 59 |
| 2016 July | 24 | 9 | 33 |
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