New Study Shows Submersion-Related Injuries Take Heavy Toll on Nations Children

April 28, 2008

Submersion-related injuries to U.S. children result in approximately $10 million in direct hospital costs each year according to research conducted by investigators in the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. The study, published in the April 2008 issue of Injury Prevention, examined the characteristics of unintentional submersion-injury-related hospitalizations among children ages 0-20 years, as well as their associated costs.

Submersion injuries occur when a person is not able to breathe as a result of being immersed in a liquid, usually water. While they often happen around large bodies of water such as swimming pools, lakes, or oceans, submersion injuries among children can also happen in the home anywhere there is water such as in bathtubs, toilets, sinks, and even buckets.

In 2003, there were an estimated 2,490 submersion injury-related hospitalizations among children 20 years of age and younger in the U.S.  Children younger than 5 years had the highest rate of hospitalization and accounted for sixty-two percent of the patients hospitalized for submersion-related injuries.  Overall, males accounted for nearly twice the number of hospitalizations as females.

“Drowning is second only to motor vehicle crashes as a cause of unintentional injury death among children 20 years of age and younger in the U.S.,” said Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy and Associate Professor of Pediatrics at The Ohio State University College of Medicine.  “These fatalities and the high hospital costs seen among pediatric patients hospitalized for submersion injuries underscore the importance of this public health problem among children.” 

Recommended strategies for the prevention of childhood submersion injury or death include: four-sided pool fencing with a self-closing, self-latching gate; close supervision by adult care givers around pools and other bodies of water;  CPR training for child care providers in homes with a pool; poolside telephones; pool alarms and covers; swimming lessons and water safety education for older children/adolescents; avoidance of alcohol use during water recreation; prevention of unsupervised toilet and bathtub access by young children; and removal of water from pails and buckets immediately after use.

“Child drowning is quick, silent, and final,” said Smith. “If a child falls and breaks an arm, he/she will recover and get a second chance, but a child rarely gets a second chance after a submersion event.”

Researchers analyzed data from the Kids’ Inpatient Database, which is part of the Healthcare Cost and Utilization Project.  Cost data excluded pre-hospital care, non-covered charges, physicians’ fees, or costs for patients who died before being admitted to a hospital or who were treated in emergency departments and released.

The Center for Injury Research and Policy (CIRP) works at the local to international levels to reduce death and disability due to injuries through research, education, advocacy and advances in clinical care. CIRP aims to improve the scientific understanding of the epidemiology, prevention, acute treatment, rehabilitation and biomechanics of injuries. CIRP educates health and other professionals, policy makers, and the public regarding the importance of injuries, injury research, and injury prevention. CIRP provides leadership in the development, implementation and scientific evaluation of public policy regarding control of injuries. CIRP provides leadership and technical assistance in injury research and prevention science. Learn more about CIRP at

About Nationwide Children's Hospital

Named to the Top 10 Honor Roll on U.S. News & World Report’s 2019-20 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit freestanding pediatric health care systems providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children and adolescents, as well as adult patients with congenital disease. Nationwide Children’s has a staff of more than 13,000 providing state-of-the-art pediatric care during more than 1.5 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded freestanding pediatric research facilities. More information is available at