With more nice weather, and our natural abundance of water, it is time to think about water safety.

Everyone understands the dangers of drowning, but it remains the number-one cause of injury related death in 1- through 4-year-olds, and the third leading cause of unintentional death in 5- through 19-year-olds. Toddlers and male adolescents are at the highest risk. In Washington State most drowning occurs in lakes and rivers. But children, especially toddlers and preschoolers, can drown in any standing water, even buckets, toilets, bathtubs and, of course, pools.

Tragedy struck for one of the families in my practice: A 4-year-old weak swimmer was at a large family picnic, with many people swimming in a pool. His mother was worried about it and had him in a life jacket for the party. She pulled him from the pool to eat his lunch. She briefly ran back into the house to get more food and came back out. He was gone, but the life jacket was on the ground. With absolute fear she ran to the crowded pool, full of their extended family. She searched all over and did not see him. She ran around the yard, calling for him, but still did not find him. Feeling sick, she went back to the pool and yelled for all to look. He was at the bottom of the pool and not one of the many adults in the pool had noticed. Please be safe.

Here are the recommendations from the American Academy of Pediatrics:

• Never – even for a moment — leave young children alone if near water of any kind in the home (bathtub/bucket/toilet), yard (pool/spa/wading pool), or neighborhood (pond/ditch/standing water).

• Understand the drowning risks at home. Infant bath seats are not drown-proof. The seat can tip over or the baby slip out, drowning in even a few inches of water. After using a pail or bucket immediately empty them before a toddler can lean in. Never leave a young child alone in the bathroom because of the danger of the toilet. Toilet locks may be helpful, but because they are annoying to use, families frequently stop using them. Never allow unsupervised access to a swimming or wading pool or any open water.

• Designate a “water watcher” whenever children are in or around water. The “water watcher” should keep focused on the child, never using the telephone or texting, socializing, or doing chores, as those are common distractions that lead to tragedy. For young children (from newborns through 4-year-olds) and any weak swimmers, a supervising adult with swim skills should use “touch supervision”— always be within an arm’s length. “Water watchers” are not being safe if they are impaired and should not use alcohol or drugs. Hand-offs should be called out from one “water watcher” to another, and verified. Supervising adults must also be able to recognize a child in distress, safely perform a rescue, initiate CPR, and call for help. Remember lifeguards are only one layer of protection, and children in and near water require contact supervision even if a lifeguard is present.

• Barriers should be used. A four-foot, four-sided, isolation fence that separates the pool from the house with a self-closing, self-latching gate is the safest. Detailed guidelines for pool safety barriers are available online at the Consumer Product Safety Commission (www.cpsc.gov).

• Some families us pool alarms and weight-bearing pool covers as supplemental protection, but data is lacking whether those reduce access more than fencing and supervision.

• Parents, caregivers and pool owners should know CPR and have immediate access to a telephone and U.S. Coast Guard approved rescue equipment: life buoys, life jackets and reach tool.

• Swimming lessons and water safety skill training for children and parents is effective prevention. Not all young children are ready to learn water survival skills and swimming at an early age. Take into account the child’s frequency of water exposure, emotional maturity, physical and developmental limitations. Remember swim lessons do not “drown-proof” a child. There must always be adult supervision.

• Swim lessons should continue until the child has basic skills: Ability to enter the water, surface, turn around, propel oneself for at least 25 yards, float or tread water, then exit the water.

• Be vigilant about access to water whenever a young child visits a home or business where there is access to a pool, hot tub or pond. Look for effective barriers and provide constant “water watcher” supervision.

• All children and adolescents should wear U.S. Coast Guard-approved life jackets whenever they are on a boat, raft, inner tube or swimming in open water like lakes, rivers or the ocean. Use a life jacket on young children whenever they are even near the water on a beach or dock, and school age children while on docks and river banks. Parents should wear life jackets when boating to model safe behavior and to be ready to save a child who may have fallen in. Also fasten the life jackets, and don’t use air-filled swimming aids (like floaties) as a substitute.

• Always know the depth of water before permitting children to jump or dive in. Jumping or diving into water can result in devastating spinal injury.

• Parents should select an area of open water swimming based on the available lifeguards and only in designated areas. Consider weather, tides, waves, water currents and the temperature of the water. Swimmers should know what to do if they are caught in a rip current.

• Don’t let children walk, skate or ride on weak or thawing ice on any body of water.

For more information, see Seattle Children’s Hospital Water Safety pages online at https://bit.ly/2MzNc4R.

Danette Glassy, MD, FAAP is part of the Mercer Island Pediatrics team.