Introduction
Drowning happens when a person cannot breathe because their mouth and nose are under water. When this occurs, oxygen cannot reach the brain, and serious injury or death can happen within minutes. Drowning can occur quickly and silently, and it often does not look dramatic or involve splashing or shouting.
Locally, exposure to water is a routine part of daily life. Many households have access to private swimming pools, and the sea is a popular recreational setting for families throughout the entire year. Due to this, understanding the risks and knowing how to prevent them is essential to keeping children safe.
Why are Children at Increased Risk
Around the world, drowning is one of the leading causes of injury-related death in young children, especially in those under five years of age. Children are not simply “small adults”, their immature reasoning ability makes them more vulnerable to drowning.
• Young children are naturally curious and often wander away quietly and explore without understanding danger.
• Toddlers are unsteady on their feet making it very easy for them to fall into bodies of water from which they may not be able to lift themselves out of.
• Children have limited swimming ability. Even those who have had swimming lessons can quickly become overwhelmed by deeper water, waves or fatigue.
• Children rely entirely on adults for supervision and protection. Brief periods of inattention may be enough time for a child to enter the water unnoticed.
All this highlights that it is crucial that children are always supervised when in the vicinity of water this is the most important protective measure.
Where Drowning Can Happen
At Home and Around Pools
In the domestic setting pools pose the largest risk. Many residences have pools which are directly accessible by children, not employing physical barriers such as gates, fences, or pool covers. Pools are not the only hazard in the household with baths, buckets and basins all presenting drowning risks. Children can drown in even a few centimetres of water and therefore should always be supervised during bathing.
At the Beach
Going to the beach is a popular pastime in Malta, however the sea carries additional risks. Strong currents, waves and sudden changes in depth pose significant risks to children, whilst rocky beaches can be slippery and uneven, increasing the changes of falls into water. As always, the most crucial preventative measure is direct supervision.
Recognising Drowning
Drowning is often quick and silent and does not look like the dramatic scenes portrayed in films. A child who is drowning is typically unable to shout, wave, or call for help as they are struggling to breathe.
The following signs may suggest that a child may be drowning:
• Head low in the water with the mouth at water level.
• Head tilted back with mouth open.
• Unfocused or blank expression
• Vertical body position with little to no kicking
• Attempting to roll onto back
• Gasping, hyperventilating or struggling to breathe
• Making repeated downward arm movements as if pushing against the water
• Sudden silence during active water play
If a child is in water and you are unsure if they are safe, check on them immediately by calling out to them and loudly asking if they are okay. If there is no response remove them from the water at once. 
Any child who has been submerged, even if just for a short time, should be observed carefully. Medical attention should be sought if there is:
• Persistent coughing
• Breathing difficulty
• Unusual tiredness
• Chest discomfort
• Behavioural change
These symptoms may occur up to hours after the near-drowning event and present as secondary drowning. Secondary drowning is a potentially fatal phenomenon that occurs due to lung lining irritation after water inhalation. Any of the above symptoms in the hours post a near-drowning event should prompt the seeking of urgent medical attention.
Responding to a Drowning Child
1. Remove the child from the water safely
Take the child out of the water as quickly as possible. Do not enter deep or dangerous water if doing so puts you at risk.
2. Check Responsiveness and Breathing
Once the child is out of the water:
• Check if they respond when you call their name or tap/shake them
• Look for normal breathing by trying to feel their breath against the side of your face whilst looking at their chest. Occasional gasping is not normal breathing
• If the child is not breathing normally, begin emergency action immediately
3. Call Emergency Services – Dial 112
• If you are not alone, instruct someone to call 112 immediately while you begin resuscitation
• If you are alone, begin CPR for one minute before calling 112, if necessary.
4. Start First Aid
For a child who is not breathing:
• Place them on a firm, flat surface
• Start by giving 5 rescue breaths
• Begin chest compression in the centre of the chest
• Press down about one-third of the chest depth
• Aim for a rate of 100-120 compression per minute
• Continue in cycles of 30 chest compressions to 2 rescue breaths*
• Continue CPR until:
o The child starts breathing normally
o Emergency services arrive
o You are physically unable to continue
For a child who is breathing but unconscious:
• Place them on their side in the recovery position
• Keep them warm
• Monitor their breathing until help arrives
* "If trained in paediatric basic life support the recommended approach is to begin with 5 initial rescue breaths, followed by cycles of 15 chest compressions to 2 rescue breaths (15:2)"
Drowning Prevention
1. Provide Constant and Active Supervision
The most important protection is close, undivided supervision whenever children are near water. Young children should always be kept within arm’s reach and under constant watch. Distraction such as mobile phones, drinking alcohol and even speaking to other people should be avoided when minding children near or in water. In large social gatherings, a designated child minder should be appointed to avoid diffusion of responsibility, simply assuming that someone must be watching the children is not enough.
2. Make Pools Safer
The following measures should be implemented to make pools safer:
• Install fencing to separate the pool from the residence
• Ensure that gates are self-closing and self-latching
• Keep gates locked at all times
• Remove toys from the pool area after use to ensure that children are not tempted to reach for them.
• Pool covers may provide additional protection yet are not a substitute to fencing and supervision.
3. Practise Safe Behaviour at the Beach
When visiting the beach:
• Swim in official bathing areas (List Accessible at: Official Bathing Zones - The Department)
• Attend beaches which have lifeguards during the bathing season.
• Ensure sea conditions are safe prior to allowing children to enter the water
• Keep young children within arm’s reach in the water
• Ensure that your child informs you prior to entering the water.
Flotation devices such as inflatable armbands and air mattresses provide support but should never replace supervision. Teaching children to swim or sending them to swimming lessons is advisable, however they are not substitutes for close active supervision. A child who knows how to swim is still at increased risk of drowning when compared to an adult. 
4. Reduce Water Hazards in the Home
Always keep in mind that small amounts of water can be dangerous for young children
• Never leave children unattended when bathing.
• Empty buckets and basins immediately after use.
• Keep bathroom doors closed when not in use
5. Learn CPR and Basic First Aid
In an emergency, knowing basic first aid and CPR can be the difference between life and death.
Conclusion
Drowning is fast, silent and preventable with most drowning incidents occurring in familiar environments and during brief lapses in supervision. By recognising hazardous settings, maintaining constant and active supervision, securing access to water, and knowing how to respond in an emergency, families can significantly reduce the risk. Through simple and consistent safety measures we can protect children and prevent avoidable tragedies.