Drowning and near-drowning are major causes of childhood mortality and morbidity from injury. From 1980 to 1985, drowning was the second leading cause of injury death of infants and children younger than 15 years of age in the United States.1 In 18 of the 50 states, drowning was the number one cause of unintentional injury death of children 1 to 4 years of age.1 Children less than 5 years of age and young people aged 15 to 24 years have the highest drowning rates.2 Drowning, by definition, is fatal; near-drowning is sometimes fatal. Drowning has been defined as a death resulting from suffocation within 24 hours of submersion in water; victims of near-drowning survive for at least 24 hours.3 For every child who drowns, four children are hospitalized for near-drowning.4 One third of those who are comatose on admission but survive suffer significant neurologic impairment.4 The annual lifetime cost attributable to drowning and near-drowning in children less than 15 years of age is $384 million.3 The annual cost of care per year in a chronic care facifity for an impaired survivor of a near-drowning event is approximately $100 000.4

There is no national surveillance system that defines the circumstances surrounding a drowning event well enough to enable the development of effective preventive strategies for children. A need exists to establish uniform state or local surveillance systems that consider developmental age groupings and geographic location and that account for environmental and behavioral factors that place children at risk. To design preventive strategies aimed at specific risk factors, such surveillance systems must define in sufficient detail the circumstances under which the drowning event occurred, preventive measures used, rescue efforts made, and the outcomes.

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