Presenter Profile
Molly B. Johnson, M.AmSAT, PhD
Drowning Prevention and Water Safety Program
Trauma and Injury Research Center
Dell Children's Medical Center
molly.johnson2@ascension.org
Dr. Molly Johnson is the research scientist for the Dell Children’s Medical Center’s Drowning Prevention and Water Safety Program in Austin, TX and an adjunct Kinesiology Professor at the University of the Incarnate Word. Her research focuses on drowning risk and prevention in children. Dr. Johnson also maintains a private practice as a Shaw Method swimming instructor and an Alexander technique specialist, working with clients to reduce pain and injury risk. As a member of the leadership team of the Texas Water Safety Coalition, Dr. Johnson is helping write the first Texas Water Safety Strategy and build a network of professionals devoted to drowning prevention.
Presentations
Parental Perspectives on Water Safety Challenges for Children with Autism
Barbara D. Cosart, MLIS, MPH, CHES
Stewart R. Williams, MBA
Karla A. Lawson, PhD, MPH
Molly B. Johnson, M.AmSAT, PhD
Among children with autism, drowning is the leading cause of death through age 14. Autistic children are more likely to drown than neurotypical children. Attributes, such as wandering, sensory issues, impulsivity, and a limited sense of danger, could increase risk. In addition, autistic children often have trouble participating in structured group activities, such as swimming lessons. The purpose of this study is to better understand water safety experiences of parents of children with autism.
Parents of children with autism were asked to complete a brief online survey and to participate in a focus group about their water safety experiences. Six focus groups consisting of 2-6 participants, and one individual interview were held. Focus groups and interviews were recorded and transcribed by the study team. The codebook, created using both deductive and inductive approaches, was revised throughout the study period to aid in thematic analysis of the participants’ contributions.
Twenty-one parents participated in a focus group or interview (95% female, 5% male, average age 44 years). Participants were parents of 1-3 children with autism (n=25, 72% male, 20% female, 8% Trans/non-binary, average age 11 years). Parents reported that 43% of the children had completed multiple years of swim lessons; 33% had completed multiple sessions; 14% had attempted, but not completed more than one session; and 10% had never attempted swim lessons. Several major themes were identified that were near-universal among participants. Parents viewed the experience and training of swim instructors teaching autistic children as being of paramount importance. They highlighted characteristics such as impulsivity, elopement, poor sense of danger, and sensory and communication challenges that affect risk of drowning and participation in learn-to-swim programs. Parents pointed out barriers in accessing adaptive swim lessons due to scarcity of experienced instructors and high cost of these lessons, and that they have often received inadequate information about water safety in the context of autism. Parents indicated that autistic children have uniquely different characteristics and needs presenting complexities in scheduling and adjusting activities around therapy. Parents contributed valuable insight into what would make a learn-to-swim program successful for their autistic children. This includes instructors who have a deep understanding of autism, tailored instruction according to their child’s unique sensory, behavioral, and motivational needs, and a sensory-friendly environment with few distractions.
Water safety needs to be elevated in importance for families of autistic children. Information on drowning risk and prevention should be proactively provided. Barriers to adaptive swim lessons such as cost, scheduling, and availability need to be addressed. More training opportunities need to be provided to swim instructors to improve teaching children with complex needs, such as those with autism.
Identify several individual characteristics that are prevalent among autistic children that contribute to a higher risk of drowning
Identify several prevalent challenges to water safety faced by families of autistic children
Identify barriers and facilitators to successful learn-to-swim instruction for children with autism
Pediatric Hospital Admissions for Unintentional Drowning in Bathtubs in Central Texas
Molly B. Johnson. M.AmSAT, PhD
Barbara Cosart, MLIS, MPH, CHES
Stewart R. Williams, MBA
Brent M.Troy MD, MPH
Karla A Lawson, PhD, MPH
In the US, more children 1-4 years old die from drowning than from any other cause. Additionally, drowning is a leading cause of death for children of all ages. Swimming pools are the most common drowning location for children 1-14 years old, but for infants under 1 year old, bathtubs are the most common drowning location. Additionally, older children may be at risk of drowning in a bathtub due to impaired development or disability, illness, or seizures. The aim of this study was to overview characteristics of patients treated for unintentional bathtub drownings at a large urban children’s hospital in the US.
A 10-year retrospective study was performed using medical records for all children treated for unintentional drowning at one large hospital serving central Texas, US. Descriptive data on the drowning context and outcome were assessed for the drownings that occurred in a bathtub setting.
Of the 457 children treated for drowning at the hospital, for 51 (11%), the setting of the drowning was a bathtub. Of all bathtub drowning admissions, 62.8% were female. The age of the patients ranged from 0.1 - 9.5 years. The majority of the children were <1 year old (54.9%). At the time of the incident, 94.1% were bathing during a planned bath time; the other 5.9% accessed water in a bathtub that had been filled for other reasons or filled the tub without permission. Of the 87.2% of adults intending to supervise the child around water during planned bath time, only 19.5% were supervising during the incident. In over one third of cases, the reason for a lapse in supervision was that the caregiver was performing bath-related chores, most often getting a towel. It is suspected that submersion was precipitated by a seizure in 11.8% of the children, including all children over 6 years old. Of the children who submerged in a bathtub, 45.1% were not breathing when removed from the water, 54.9% received a CPR-based rescue activity immediately after being removed from the water, and 13.7% received CPR from a medical professional. Additionally, 35.3% were discharged home from the Emergency Department following evaluation and/or treatment;13.7% of the incidents resulted in death or morbidity.
Bathing poses a drowning risk for children, particularly those under 1 year old and children with a history of seizures. Focused supervision is a critical layer of protection, yet lapses in supervision are common. Drowning prevention initiatives should emphasize the importance of gathering towels and clothing before starting water for a bath and avoiding distractions, including chores and other childcare when a young child is in the bath.
1) Overview common drowning scenarios for pediatric bathtub drowning incidents.
2) Highlight the importance of supervision for infants and toddlers while bathing.
3) Provide evidence to support bathtub water safety messaging emphasizing gathering towels and other bath supplies prior to starting water for a bath.