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This is a life-threatening emergency. Call 911 immediately, then follow these steps while waiting for help.
Near-Drowning (Submersion Injury) Response
Content reviewed against published AAP, CDC, WHO guidelines
Last reviewed:
Drowning is the leading cause of death in children ages 1-4 and can happen in as little as 1 inch of water in under 60 seconds. Near-drowning means the child was submerged but survived. ALL near-drowning events require emergency evaluation, even if the child appears fine afterward. Secondary drowning (pulmonary edema) can occur hours later.
Immediate actions
- Call 911 immediately
- Remove child from water immediately
- DO NOT: Do NOT waste time trying to get water out of the lungs — begin CPR if not breathing
Step-by-Step Response
Remove from water
Get the child out of the water immediately. Support the head and neck (possible spinal injury if diving or jumping was involved). If in a pool, lift straight up or support while climbing out.
Check for responsiveness
Tap the child and call their name. If no response, check for breathing — look for chest rise, listen for breath sounds, feel for air on your cheek. Take no more than 10 seconds.
Begin CPR if not breathing
For infants: 2 finger chest compressions, cover mouth and nose for breaths. For toddlers/children: heel of one hand for compressions, pinch nose and cover mouth. Give 30 compressions then 2 rescue breaths. Compression depth: 1/3 of chest depth.
Call 911
If alone with an unresponsive child, give 2 minutes of CPR (5 cycles) then call 911. If someone else is present, have them call while you perform CPR. Do not stop CPR to make the call if alone.
Continue CPR
Continue CPR until: child starts breathing on their own, emergency responders take over, or you are physically unable to continue. Drowning victims can sometimes be revived even after prolonged submersion — do not give up.
If child is breathing
Place in recovery position (on their side). This allows water and vomit to drain and prevents aspiration. Monitor breathing continuously. Keep child warm — wet children lose heat rapidly.
If child vomits
Turn child on their side (or turn head to side if spinal injury suspected) to prevent aspiration. Clear the mouth of vomit. Resume CPR if child stops breathing after vomiting.
Go to the ER — no exceptions
Even if child appears completely recovered (coughing, crying, talking), ALL submersion events require ER evaluation. Secondary drowning/pulmonary edema can develop 1-24 hours later and can be fatal without treatment.
What NOT to Do
- ✕Do NOT waste time trying to get water out of the lungs — begin CPR if not breathing
- ✕Do NOT assume the child is fine because they are crying/coughing — all submersion events need ER evaluation
- ✕Do NOT perform abdominal thrusts (Heimlich) to remove water — this is not a choking event
- ✕Do NOT leave other children unsupervised to help the drowning child — yell for another adult
- ✕Do NOT jump into water to rescue unless you are a strong swimmer — extend a pole, rope, or flotation device
- ✕Do NOT delay CPR to call 911 — start CPR first, call after 2 minutes if alone
When to Seek Help
Call 911 if:
- Any submersion event where the child was not immediately responsive
- Child needed CPR after submersion
- Child is coughing persistently, wheezing, or having any difficulty breathing after being removed from water
- Child was submerged for any period of time and is lethargic or confused
- Child is vomiting after a submersion event
- Child was found face-down in water
- Any submersion event involving a baby under 12 months
Go to ER if:
- ALL near-drowning/submersion events — no exceptions, even if child seems fine
- Child coughed up water and now seems fine — still needs evaluation for secondary drowning
- Child was underwater for more than a few seconds
- Any change in behavior or breathing in hours after a water event (delayed drowning symptoms)
- Persistent coughing, wheezing, or chest tightness after water exposure
- Child is unusually tired or confused after a water event
- Any difficulty breathing developing in the 24 hours after submersion
Call your doctor if:
- Child fell in water briefly but seems completely fine — call for guidance on monitoring
- After ER discharge, for follow-up care and monitoring instructions
- Child is coughing occasionally after a minor water event (went under briefly at pool)
Age-Specific Guidance
0-12 months
Babies can drown in as little as 1 inch of water — in bathtubs, buckets, pet bowls, or toilet bowls. NEVER leave a baby alone in the bath, even in a bath seat (they can tip over). Bath seats are NOT safety devices. A baby should be within arm's reach at all times near any water.
1-3 years
Toddlers are the highest-risk group for drowning. They are mobile, curious, and top-heavy (large heads relative to bodies). They can wander to pools, fall into ponds, or climb into buckets. Pool fencing is the single most effective prevention measure. Drowning is the #1 cause of death in this age group.
3-5 years
Still at very high risk. May wander to neighborhood pools or water features. Overestimate their swimming ability. Even children who have had swim lessons can drown. Designated adult supervision is required at all times. Teach children to always ask permission before going near water.
Prevention
- NEVER leave a child unattended near water — not even for a moment (drowning happens in seconds)
- Maintain constant, dedicated adult supervision — designated "water watcher" who does not use their phone
- Install 4-sided fencing (at least 4 feet high) around all pools with self-closing, self-latching gates
- Empty all buckets, basins, wading pools, and bathtubs immediately after use
- Keep toilet lids locked — toddlers can fall in headfirst and cannot get out
- Start swim lessons at age 1 (AAP recommendation) — but know that lessons do NOT make a child drown-proof
- Use properly fitted Coast Guard-approved life jackets for all children near open water
- Do NOT rely on water wings, pool noodles, or inflatable toys as safety devices — they are not life-saving equipment
- Learn CPR — minutes matter in drowning and EMS may not arrive in time
- Be aware that drowning is SILENT — children rarely splash or cry out
- Remove pool ladders when not in use (above-ground pools)
Frequently asked questions
Should I call 911 for near-drowning (submersion injury) response?
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What should I NOT do?
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Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Emergency Guides
Bottom line
This is a serious emergency. Always call 911 first, then follow the steps above while help is on the way.
You are doing the right thing by learning what to do in an emergency. Being prepared is one of the best things you can do for your child.