By Eve Switzer, MD, FAAP

“It happened so fast.”

I think it was this sentiment that resonated the most with me at the AAP’s Annual Leadership Forum in March.  Three families were invited to address the leaders of the AAP in conjunction with the roll out of an AAP Policy statement about drowning prevention.

Dr Ben Hoffman and Dr Lynn Olson first shared some sobering statistics about preventable injuries in the US.  28 children per day die from a preventable injury.  Injuries are 1/3 of the deaths in children age 1-18 years.  Drowning is the leading cause of preventable injury death in children 1-4 years of age.

With the advent of antibiotics and vaccines, we saw these preventable injuries rise as the leading cause of death in children.  Tremendous impact has been made on both drowning and sleep deaths but progress has slowed or stalled.

In Oklahoma, we are one of 10 states with the highest unintentional injury death rates including deaths from drowning.  Injury mortality is currently increasing in 10-19 year-olds according to the national vital statistics report from the CDC.  When suicide and homicide are added, these injuries account for 60% of childhood deaths.

With the Back to Sleep campaign in 1994, we have seen SIDS rates cut in half but progress has now stalled and disparities remain.  It’s clear that the work of the AAP and of pediatricians in practice have had a significant impact on these rates but more needs to be done.  This message was repeated by each of the 3 families who told their stories.  And, as Dr Hoffman pointed out, once we heard these stories, we couldn’t unhear them.

Bode Miller addressed the Forum first.  He briefly mentioned that his maternal uncle had drowned and, as a result, felt that his family was sensitive and responsible in terms of water safety.  On June 10th of 2018, he and his children had gone swimming just that morning at home. Their pool was fenced, and the older children had had swim lessons.  They visited friends at a house where the pool wasn’t fenced but as everyone mingled outside, it was noted that none of the children went near the pool.  At another friend’s house later that afternoon, where there had been a pool fence recently removed because the family’s children were older, the adults socialized in the living room.  Bode’s wife noted the absence of their youngest daughter, Emmy, and the back door was open.  It was only a couple of minutes.  Emmy had drowned.

I searched in vain for a tissue in my bag.  The Grand Ballroom was completely silent.  Tears ran down nearly every face in the room.

Nicole Hughes then described the joy that 3 year old Levi brought to their family.

Also on June 10th, 2018, on their 7th annual beach trip to Alabama, she recounted her story of sharing a brownie with Levi, turning to close a bag of Cheetos, then noticing that Levi had slipped out.  She went to the balcony of their rental house, still chewing on her half of the brownie when she saw Levi at the bottom of the pool.  “This is how fast it happens”.

Eight years before Nicole was even born, their family had lost her cousin to drowning but this wasn’t ever discussed.  “Drowning stigma is the greatest threat to drowning prevention,” Nicole stated.  “It’s not inattentive or neglectful parenting.  Levi didn’t have the skills to protect himself.  We can fix this,” Nicole promised.  Nicole founded the non-profit Water Guardians: Levi’s Legacy to increase awareness about drowning prevention and distribute educational resources. Pediatricians can print flyers or request magnets and Water Guardian tags to distribute to patients and parents in their office.

Sam Hanke, a pediatric cardiologist then shared the story of what he called the worst day of his life.  He recounted the events that night in the hopes of putting a story and face to this tragedy.  Babies die every 3 hours in the US without a voice.  In April of 2010, their son, Charlie, was 3 weeks of age.  Sam was a pediatric chief resident.  While holding Charlie on his chest, Sam was watching TV and fell asleep.  When awakened by his wife for Charlie’s next feeding, the newborn was lifeless.  Sam performed CPR on his own child but couldn’t save him.

On what would have been Charlie’s first birthday, the Charlie’s Kids Foundation was established (www.charlieskids.org) educating others about putting babies to sleep in safe positions.  Over 3 million copies of their board book, “Sleep Baby Safe and Snug” have been distributed.  “3500 babies is way too many.  We can do better,” Sam finished.

* To help in our efforts as pediatricians to bring attention to water safety, the AAP’s new policy statement is here: https://pediatrics.aappublications.org/content/early/2019/03/13/peds.2019-0850

* The OKAAP has added a resource page for drowning prevention here: https://www.okaap.org/drowning

* The AAP Panel on Drowning and Sudden and Unexplained Infant Death 2019 recording from the ALF can be viewed here:  https://www.youtube.com/watch?v=ca6VPQO8jcQ

I’ll never forget Nicole’s words as she described what likely happened at the end of Levi’s life:  “He’s scared.”  All of the AAP leaders stood as one and applauded the families for sharing their stories.  It’s a shame that it takes tragedy to inspire action but it’s safe to say that we were all inspired by these families to do better.