In the latest installment of our occasional conversations with Fort Worth newsmakers, Dana Walraven, manager of community health outreach at Cook Children’s Health Care System, shares best practice when it comes to protecting children from drowning.

This conversation has been edited for length and clarity. For an unabridged conversation, please listen to the audio file attached to this article.

Alexis Allison: Dana, at the end of May, Cook Children’s had seen a record number of drownings for the year. Can you tell us what’s going on?

Dana Walraven: Yes, well, the rise actually started occurring between January and March. We were tracking an unprecedented number of drownings. And what we know is that we’re a southern state with a lot of backyard pools with a lot of open water, and a lot of families moving into the area. 

Allison: I’ve seen the phrase ‘drowning injury’ in some of Cook Children’s correspondence about this topic. Can you tell us what that means?

Walraven: Absolutely. I’m so glad you asked. (By Friday, June 10), we have treated 29 children for drowning, four of which were fatal. But when we talk about drownings, it’s actually a process. As soon as an individual, whether it’s a child or an adult, is submerged into a liquid, that begins the process of drowning. Now you can stop it at any point, of course. The endpoint is the fatality. 

The six stages of drowning:

  1. Struggle to keep the airway clear of the water
  2. Initial submersion and breath-holding
  3. Aspiration of water
  4. Unconsciousness
  5. Cardio-respiratory arrest
  6. Death – inability to revive.

Source: Medico-Legal Journal

But the longer they’re there, in that process of being submerged in a liquid, there’s higher potential for injury along the way. We always hope that it’s a quick pullout of a child or an adult in that drowning scenario. And hopefully, an easy recovery from there. But the longer they are in that process, you have opportunities to have less oxygen to the brain, lung injuries, different injuries that can occur the longer they’re in that liquid and can’t breathe.

Allison: You mentioned pools and other bodies of water. Are there any other circumstances where a child might be in danger of drowning?

Walraven: Yes. The typical drownings that we treat at Cook Children’s are typically pool — that’s the highest volume, understandably, with all the backyard pools, community pools, hotel pools. However, the others are going to be open water, which could relate to a lake, a pond, a river, any type of open or natural water. And then we also have quite a few bathtub drownings. And so those are things that we can see all year round, not only in the swim season.

Sometimes we have scenarios where, typically a young child, will drown in a bucket or a cooler. It really is about the age range and their ability to pull themselves out of water. It takes only a very little amount of water — just enough to cover the nose and mouth — to where a drowning scenario can happen. 

Allison: Are there certain misconceptions that you’ve encountered about drownings and drowning prevention?

Walraven:  Well, it’s important to know that drownings can happen in seconds. So, when we talk to adults, we need them to understand that, in most scenarios, we’re really great multitaskers. But when it comes to a child around water, we really need to stay vigilant. We have to stay in reach of those children in and around water. And when we’re not planning to be around water, we need to really put things in place to prevent a child from getting to the water without our knowledge.

Safety tips for home swimming pools: 

  • Restrict access by installing door locks high out of children’s reach. Door and window alarms can signal if someone leaves the house. 
  • Install four-sided fencing around pools with a self-latching gate that only opens out. The fence should be at least four feet (preferably five feet) high. 
  • Remove all toys and floats from the pool area so children are not tempted to get close to the water. 
  • For above-ground pools, make sure the ladder is removed and not accessible when it’s not swim time. 
  • Consider a pool surface alarm to alert if anyone/anything falls into the water. 

Safety tips for bathtubs: 

  • An adult must stay at the side of the tub in reach of the child. 
  • Pay attention. This is not the time for multitasking. 
  • Ignore distractions like the doorbell or phone calls. 
  • Drain the tub after each use. 

For more information about drowning prevention, go to

Source: Cook Children’s Health Care System

Allison: Can you tell us a little bit more about those safety precautions and what they could look like?

Walraven: Families should plan around two different types of scenarios. So we want them to think through both planned swim time — when they know they’re going to take (a child) to water. The other is unplanned swim time. What kinds of things can they plan ahead to prevent that child from accessing that water without their permission, without their direct, non-distracted supervision? 

And so to do that, we want to make sure families think through what we call ‘water watchers.’ That’s designating someone to be watching all the heads in the water. During that planned swim time, we want to make sure they’re staying in reach. And not multitasking. Mowing the lawn is very different than being right there, where the kiddos are swimming, whether it’s at the lake side, or a pool type of environment. And so with that, if you don’t have someone to share that designated responsibility, then it’s important to take breaks during swim times. If you need to return a phone call or anything, you get everyone out of the pool and make sure that the pool or lake area is cleared of all the kids. 

What we have to really watch is that transition time, when everyone’s transitioning to that indoor activity, or somewhere away from the water’s edge: Are all the kids clear and out of the water, or did they take the lifejacket off early and go back to the water? So a lot of scenarios we see, the adults are doing great things, are putting a lot of the safety pieces in place, but it’s that transition time with all the distractions that can sometimes be a challenge.

Dana Walraven. (Courtesy | Cook Children’s Health Care System)

Allison: Can a child drown while wearing a life jacket?

Walraven: Well, we want families to really understand the difference of what they’re putting on their child as far as a safety device. And so you want to make sure that a lifejacket is U.S. Coast Guard-approved. That means it’s gone through all the rigorous testing to make sure it’s going to be a safety device where the child’s head or the adult’s head can stay above the water, where they can catch their breath. 

Allison: You also mentioned unplanned swim times. What tips would you give caregivers to prevent risk during those moments?

Walraven: Well, really do a home evaluation, or when you’re visiting others, evaluate their space where the child might be able to access water when the adult does not know they’re heading in that direction. So we want people to put a lock on a door that accesses the pool or lake or pond areas, one that’s out of reach of the child. 

We want families to think about doggie doors. The highest volume of drownings are children (ages) 1-4. And so if you have toddlers crawling, they can get out those doggie doors. It seems so minimal, but we actually get quite a few drownings from that type of scenario. Make sure the windows are locked, the doors are locked. A lot of families will invest in any kind of alarm, whether it’s a pool alarm, a door alarm that accesses the patio area, or even a child alarm. They have some that go on a child’s wrist, they can’t choke on it, they can’t take it off. And if it’s submerged into water, it will alarm. So there’s all sorts, depending on the family’s preference.

Allison: Thank you for those. I know that Memorial Day weekend is typically one of the worst weekends for drowning patients at Cook Children’s. How did Memorial Day weekend recently go?

Walraven: Well, it’s expected that any holiday is going to bring more injuries associated with that holiday and so, Memorial Day, we did have an increase in drownings. The holidays typically bring a wider rate range of age groups of children. Just because there are more of every type of child, every family member, there’s more of everyone out doing those activities. And so we see a wider age range of drownings. We also see a wider range of drowning scenarios that you don’t typically see throughout the year. And so we anticipate that, we’re ready for it. But it is our goal to try to make sure that families are aware of all the pieces of safety and prevention so that we are preventing these more than we’re treating them.

Allison: Is there anything else that you’d like to share?

Walraven: We can never reinforce enough: swim lessons. The more (children) can learn water rescue skills, the better, because a lot of children will find themselves fatigued in the middle of a pool that they can’t touch the bottom, or out in a lake where they can’t reach the water’s edge or the dock. And so we want to make sure we’re putting children in safe environments, but knowing that they’re still building their swim skills. The key, the No. 1 thing, is adult, in-reach supervision. 

And Alexis, families can go to They can order our Water Watcher tags — those designated adults to watch the water. They can learn who in their region is offering swim lessons, life jackets. We have so many resources if families want to learn a little bit more.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....