“For us, in the Emergency Department, it’s just sad because this is something that’s totally preventable,” Dr. Warmink said. “It was an unusual summer because of the number of kids who came here because of drowning, but it’s something we see all the time. It’s not a freak occurrence. We live in Texas. There are a lot of pools here. It’s just water and children don’t mix without supervision.”

Dr. Warmink understands that people focus on the number of fatal drownings that occur during a given year. But he says that a near drowning can be devastating for a child.

“Kids come in here and they don’t die, but we know that their outcome is not going to be a good one,” Dr. Warmink said. “People think, ‘He didn’t die, so everything will be great.' But often times, that’s not true. There is a large subset of children who survive, but end up with catastrophic outcomes.”

Time under water = brain

Dr. Warmink describes drowning as the inability to breathe, normally due to submersion in a liquid, usually water.

The outcome, including death, of the person who drowned depends on how long he or she was under water.

“Everything is based on getting oxygen to vital organs,” Dr. Warmink said. “The outcomes of drowning and the adverse effects are based on that lack of oxygen. The most effected parts of a drowning victim are the brain, lungs and the kidneys. The one that is most catastrophic and the one that will kill you is the brain. “

The amount of time children spend under the water while drowning usually determines their outcome. The lack of oxygen destroys brain cells and that causes damage to the brain, ranging from short term (forgetful, clumsy …) to severe (can’t walk to vegetative).

Dr. Warmink says there are several variables that shape how severe the brain damage will be, including how long the person was submerged in the water and how quickly he or she received CPR.

Once a child arrives to the Cook Children’s ER, treatment begins that may include oxygen, X-rays, intubation or medication.

“But a lot of it is supportive care for the children that come in here,” Dr. Warmink said. “We may have to support their lungs because they have been damaged and they have difficulty breathing. Their kidneys could be damaged, so we will do lab work to see what's going on there. But our biggest concern is the brain and honestly, there's not a whole lot we can do. The vast majority of treatment for drowning is supportive. We see what we can do to keep that child alive. That said the earlier you can intervene, the better. One of the things that helps outcomes is early, good CPR. By the time they get to us, it may be too late.

Adult supervision – the hallmark

As a parent, Dr. Warmink stresses supervision of his own children in the pool. He calls it a hallmark of making sure children are safe. Half of all drownings occur within 25 feet of an adult.

“Children should never be in water without adults watching them,” he said. “If you have a toddler, that child shouldn't be in water without what we call touch supervision. You need to be in hand's length and it's not just pools. That includes bathtubs or any other container with water. I've seen kids drown in buckets. A child can drown in any water, even a few inches deep.

“Supervision isn't, Hey there’s six of us cooking hamburgers and text messaging. It means there’s someone who has the designated job to watch the children in the water.”

Other layers of protection Dr .Warmink stresses include:

• Fencing around the pool. A fence on all sides of the pool has been shown to reduce fatalities by more than 80 percent.
• Swim lessons for everyone who will be in the pool, including adults.
• Coast-guard approved floating devices. Water wings and “floaties” do not constitute a floatation device.
• Drowning doesn’t look like drowning. Drowning is a silent killer. Kids aren’t kicking and flailing. Dr. Warmink says it’s usually someone looking for their child and they see them at the bottom of a pool.

“As the adult, you have to be actively watching at all times, counting even. OK, there are five kids in this pool. How many heads do i see? Kids will drown right in front of you,” Dr. Warmink said. “It's not a long process of them screaming and crying. It's just one second they are fine and the next second they are under.”

Take it from Dr. Warmink. Unfortunately, he’s had plenty of experience.

Related articles:

• Cook Children's drowning prevention page
• Drowning prevention - 9 ways to protect your kids
• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• The life-saving reason for Water Watchers

That’s the simple message that the folks at Cook Children’s who watch out for your kids’ safety wants you to know.

From March 14 to April 10, 2018, five children were rushed to the Emergency Department for drowning, with one resulting in death.

“There is no amount of time that it’s safe to leave your child alone in the tub,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s.

Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury related death for ages 1 to 14.

“Safety begins in the home,” said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition. “Bath time is not only a good time to bond with your baby, but a dangerous time in and around water. Support safe habits with adult, not sibling, supervision.”

SafeKids Tarrant County, led by Cook Children’s, gives these facts:

• Drowning is quick and silent.
• Children can drown in as little as one inch of water.
• Irreversible brain damage occurs in as little as 4 minutes.

To protect your child from drowning in the tub:

1. Never leave your child unattended in the water.
2. Put the cell phone away. Give your child 100 percent of your attention.
3. The job of supervising a child in the pool is for adults only and not siblings. A child or even a teen should not be held responsible for supervising a child in the bathtub.
4. If you have to answer the door or the phone, take your baby out of the water and hold him or her while you do so.
5. Fill the tub only with enough water to cover the infant's legs.
6. Once the bath is over, immediately drain the tub.
7. Don't rely on bath rings or seats to keep a baby safe.
8. Store empty tubs, buckets, containers and wading pools away after use. Store them upside down and out of a child’s reach.
9. Keep doors to bathrooms and laundry rooms closed.
10. Learn CPR for infants.

Learn more at safekids.org.

According to noheatstroke.org, 32 children have died in the U.S. as a result of being left in a car. In all of 2015, 24 kids died.

On Sept. 21, 2016, a 7-month-old baby died in a hot car in Huntsville, Ala. The temperature was 94 degrees. The following day, a 4-month-old child died in Geronimo, Okla. The temperature at the time was 96 degrees.

As anyone who lives in a state like Texas can attest, summer-like temperatures can occur even in winter. But it doesn’t take a scorching hot day for a child to be in danger. Heatstroke deaths have been recorded in 11 months of the year in nearly all 50 states.

“It truly doesn’t have to be a ‘hot’ day in Texas for a death to occur,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County coordinator. “The temperature inside a vehicle can quickly climb over 20 degrees hotter than outdoor temperature. So even a cool day in Texas can become dangerous very quickly. Since children’s body heat rises three to five times faster than adults, it’s important to know that temperatures can become deadly any time of year.

Heatstroke, also known as hyperthermia, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

Because of this, and because cars heat up so quickly – 19 degrees in 10 minutes – tragedies can happen faster than you think. Symptoms can quickly progress from flushed, dry skin and vomiting to seizures, organ failure and death.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans,Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

It’s hard to imagine someone forgetting a child is in the car, but human error, and people make these mistakes during their busy day-to-day lifestyle. Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

For more information

Cook Children's partners with the community to raise awareness and meet learning needs centered around injury prevention and child safety equipment. Read more about it here.

And yet, one in three parents surveyed has left their child at pool for two to three minutes without supervision.

You may have seen movies of someone drowning and splashing in the water and making a big, dramatic scene. But that’s only in the movies.

Drowning is a silent killer. In reality there’s very little splashing, waving or screaming. You likely won’t hear your child drowning until it’s too late.

“Parents should stay in the water and within arms-reach of their child,” said Sharon Evans, Trauma Injury Prevention/Outreach coordinator for Cook Children’s Medical Center. “Don’t rely on a lifeguard, or an older child, to save your child. Be in the water. A drowning can happen too quickly not to be in with a child.”

Watching your children in the pool isn’t a job for kids, even older children.

"Teens can be easily distracted and they may not have the judgement skills to handle the job," said Dana Walraven, Community Health Outreach manager at Cook Children’s. "If there's a problem in the pool, a child may have trouble getting another child out of the pool. And this is not a responsibility for a young person. A drowning, even if not fatal, can scar a child for life if something happened if he or she were in charge. This is definitely a job for a grownup."

Evans said she was alarmed at a recent event she was at when she asked children what they should do if they saw a friend drowning or struggling in the pool. Too many said they would jump in and save the child.

“That’s the last thing we want to happen,” Evans said. “The child may not be strong enough to support the other child or a strong enough swimmer to support both kids. If a kid jumps in to rescue a friend, you can easily have two victims.”

Evans said to make sure your children know the best way they can help if they see someone in trouble in the water is to run and get help. Notify a lifeguard at a pool if one is on duty or find the nearest adult. Have someone get help and call 911 immediately.

So what should you tell your child to do if they see someone drowning?

First, know the signs. The American Red Cross says to watch for these signs a person may be drowning:

• The person is upright (vertical) in the water.
• The person is unable to move forward or tread water.
• The drowning person is pressing his or her arms down at the sides, trying to keep the head above water to breathe.
• The person spends energy just trying to keep his or her head above water.

If a child sees someone showing signs of trouble, he or she should stay out of the water and look for something to grab a hold of to help the person in trouble:

• A pool noodle
• Any flotation device by the pool
• Fishing pole
• Rake
• Canoe paddle
• Boat oar
• Stick
• Tree branch
• Baseball bat

Children who are too small to pull someone in or the person in the water is out of reach, should find objects to throw in to the water including:

• Kickboard
• Empty picnic cooler
• Life jacket
• Ring buoy
• Water jug
• Basketball
• Inner tube

Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury-related death for ages 1 to 14.

SafeKids Tarrant County, led by Cook Children’s, offers other sobering facts for parents leading into this swimming season:

• Drowning can still occur even if you know how to swim.
• No one is “drown proof” – no matter their level of swimming ability.
• Falls, entrapments and injuries lead to drowning regardless of swimming level.
• A majority of people overestimate their own and their child’s ability to swim, especially in a panic.
• Drowning is quick and silent.
• Drowning occurs in as little as 2 minutes.
• Irreversible brain damage occurs in as little as 4 minutes.
• Most children who drown are out of sight or missing for less than 5 minutes and usually in the presence of 1 or both parents.
• Most children die who are submerged for as little as 6-10 minutes.
• Children who drown do not scream splash or struggle. They silently slip beneath the water, even with adults and lifeguards present.

That’s scary information, but there are steps you can take to help protect your child and have a safe summer while in the water:

1. Constant visual supervision

• Assign an adult water guardian whose only responsibility is to watch children who are in the water.
• Teach children who can’t swim to stay away from water unless they are with an adult who is within arm’s reach and has eye-to-eye contact on them.

2. Learn to swim

• Studies show that formal swim lessons for children under age 4 reduce drowning by 88 percent.
• Take swim lessons with your child if you don’t know how to swim yourself. Even adults who are strong swimmers should never swim alone.

3. Keep backyards and bathrooms safe

• Dump all water buckets and empty kiddie pools when they are not in use.
• Install safety latches on toilets
• Never leave children unattended in the bathtub

4. Multiple barriers on all pools and spas

• Install pool fences, self-closing, self-latching gates and door alarms in areas leading to pools and spas.
• Keep a phone by the pool and call 911 in an emergency
• Keep pool area picked up and clear of toys and other items which might attract an unsupervised child.

5. Always check pool/spa first for missing child

• Make sure to look at the bottom of the pool or spa.
• Do not quickly scan the top and move on – children who drown often sink to the bottom and appear as shadows that easily be overlooked.
• Every second counts.

6. Wear life jackets

• Children who cannot swim should always wear a properly sized Coast Guard approved life jacket.
• Do not rely on water wings, floats or other toys to keep children safe.

7. Learn CPR

• Studies show CPR doubles the victim’s chance of survival.
• Use hard/fast compressions in the center of the chest until help arrives.
• Refresh CPR skills yearly, certifications every two years.
• Post CPR guidelines near the pool.

Related Links

• Cookchildrens.org/safety
• Safe Kids’ Water Safety Tips
• Play it Safe on the Water - Texas Parks and Wildlife
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning

For many families, the summer means boating and swimming season. But it can also mean danger, as one of the worst drowning weekends of the year. Please take these extra precautions for a safe, fun holiday.

1. Don’t drink and drive. This takes on dual meaning, both on the road and in the water. According to the Texas Parks & Wildlife website, open containers on boats are legal, but operators of boats are subject to boating while intoxicated laws, the same as driving a vehicle. “Operators or passengers may also be subject to public intoxication laws. Drinking and boating is DANGEROUS and the cause of most boating fatalities,” the site said.

2. You also need a license. You need to know how to operate your boat, just like a car. The course is $20. In Texas a person cannot operate a windblown vessel over 14 feet in length, a motorboat with more than 15 horsepower, or personal watercraft unless he/she:

• Was born on or after September 1, 1993 and has passed a boater education class or equivalency examination prescribed by the department.
• Is 18 years of age and can lawfully operate the motorboat and is on board the motor boat when underway.
• Is at least 13 years of age and have successfully completed a boater education course approved by the Department.

3. Kids don’t get on a personal watercraft without an adult. Children under 13 are specifically prohibited from operating a PWC unless accompanied on board by a person at least 18 years of age.

4. Life jackets are an absolute must!! Everyone on any watercraft at the lake should be outfitted with a jacket. When selecting a life jacket, size matters. Learn more from the Texas Parks & Wildlife site.

5. Teach your kids to swim. Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury-related death for ages 1 to 14. Whether if it’s in a lake or a pool, your child needs to know how to swim. Learn more today or start them on swim lessons this weekend.

Arlington Fire Department's Station 7 Dive Team demonstrated the mock drowning as part of "April Pool's Day." Moms were on hand to watch the mock drowning and to listen to speakers, including parents whose children had died as a result of drowning. The event talked about the warnings signs of a child in danger and what parents could do to protect their children at the pool. 

For more information about drowning and the event, please view the following:

Cook Children's drowning and prevention information

NBC5's coverage of the event