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Haley Romine
Aleena Joseph
Vinh Diep
Nouran Farag
Elizabeth A. Camp, PhD
Rohit P. Shenoi, MD

Drowning is a public health problem. Recreational water access and swim lesson participation among children are factors that can influence pediatric drowning rates. We aimed to determine factors associated with swimming lesson participation and swimming ability among children.

Parents of children aged 0-19 years who visited an urban children’s hospital emergency department between 2022-2025 completed a survey after providing informed consent. Covariates included demographics, maternal education, parental swimming ability, child’s participation in food assistance program, Head Start, or daycare, and swimming pool access. Outcomes included child swimming class participation and swimming ability (based on child’s comfort with playing in water over their head). Descriptive statistics and group comparisons by chi-squared test and logistic regression were performed.

There were 485 children selected. The median age was 6.5 years (IQR: 3,11). Subject demographics were males (54%), Hispanic (53%), non-Hispanic White (21%), Black (20%) and Asian/Other (7%). Among preschool children (?5 years old), participation in food assistance program was 35%, Head Start (19%) and daycare (31%). Forty-eight percent of school-aged children participated in a school food assistance program.

Overall, 64% of children had swimming pool access year-round or during summer. Seventy-three percent of parents could swim. Among children, 29% attended swimming classes and 38% were very comfortable playing in water over their head. Parents of Hispanic ethnicity and Black race had lower odds of swimming ability when compared to White parents. Children of Hispanic ethnicity and Black race were significantly less likely to have attended swimming classes or be comfortable when playing in water over their head compared to children of White race.

Among preschool children, significant factors associated with swimming lesson attendance were age [OR:1.8 (95%CI:1.2,2.5)], and year-round or summer pool access [OR:20 (95%CI:4,100)]. Significant factors associated with swimming lesson non-attendance were Hispanic ethnicity [OR:0.3 (95%CI:0.1,0.9)], and Black race [OR:0.1 (95%CI:0.01,0.4)]. Similarly, among preschool children, those with year-round or summer swimming pool access were >3 times more likely to be comfortable playing with water over their head compared to children without pool access after adjustment [OR:3.4 (95%CI: 1.3,8.9)].

Among school-aged children, significant factors associated with swimming lesson participation were maternal education [OR:4.7 (95%CI:2.4,9.5)], and recreation-center pool access [OR:3.0 (95%CI:1.4,6.5)]. Significant factors associated with swimming lesson non-participation were Hispanic ethnicity [OR:0.3 (95%CI:0.2,0.6)], Black race [OR:0.3 (95%CI:0.2,0.8)] or in a school food assistance program [OR:0.3 (95%CI:0.2,0.5)]. White race and parental ability to swim were factors significantly associated with a child being comfortable playing in water over the head compared to other groups.

Significant racial and ethnic disparities in parents’ swimming ability and their child’s swimming class participation and swimming ability exist. In preschool children, swimming class participation and swimming ability are significantly associated with older age, swimming pool access and non-minority race. Among school-aged children, swimming class participation and swimming ability are significantly associated with maternal education, parent’s swimming ability, swimming pool access, non-minority status, and non-participation in food assistance program.

1. Explain factors associated with swim lesson attendance in children by age group
2. Discuss reasons for disparities in swimming ability in children by age group
3. Summarize methods to improve swim lesson attendance among high drowning risk subpopulations.

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James "Trey" Rhodes, MD
Linh Nguyen, PhD
Rohit P. Shenoi, MD

Texas ranks among the highest in pediatric drowning fatalities in the United States. Functional pool fencing reduces drowning risk in children, yet its economic benefit in preventing pediatric drowning is unknown.

We estimated the cost savings from instituting a universal fencing program in Texas among children 1-9 years old. The mean annual number of drowning fatalities in children aged 1-9 in Texas was obtained through CDC Wonder. The number of nonfatal drownings were estimated based on a drowning case-fatality rate of 1:6. Drowning burden included fatal and nonfatal drownings. The total cost of drowning was estimated using the Texas Health Care Information Collection data (2016-2022), including medical costs and indirect costs incurred by a pediatric patient and caregiver due to drowning. The average cost for a medium-sized swimming pool fence was obtained from pool companies. We assumed zero fence maintenance costs for a 10-year period since this is the average fence lifespan and time for an infant to grow into an older child not needing supervision.

Based on the literature, we estimated a fence to be 76% effective in preventing drowning. Using information on pediatric drownings in Harris County, Texas, we assumed current functional pool fencing coverage to be 38%. We also assumed each drowning case corresponds to one home, and risk reduction applies uniformly.

The number of prevented drownings was calculated by multiplying the annual number of drownings by the effectiveness rate of pool fencing and (1-coverage rate). Total cost savings were estimated by multiplying the number of prevented drownings due to pool fencing by the average cost per case. The net benefit of instituting pool fencing was estimated by subtracting the cost savings from the cost of universal pool fence installation. Cost savings per case prevented were calculated as the cost savings divided by prevented cases.

From 2018-2023, there were 264 (44/year) fatal swimming pool drownings in Texas among children 1-9 years old. Using a pediatric drowning case-fatality rate of 1:6, the annual burden of fatal and nonfatal drowning in Texas children aged 1-9 is 264 cases.

Based on the 76% effectiveness of pool fencing in preventing drowning and 38% of homes with functional fences, the annual number of prevented drownings is 124 cases. The total costs incurred by a patient and caregiver per pediatric drowning patient in Texas are $337,435 (medical costs: $60,860; lifetime indirect costs: $276,575). The annual cost savings from 124 prevented cases by instituting universal pool fencing in Texas is $41,841,940. With the average cost for a medium-sized swimming pool fence of $3,343, the total cost of installing a functional fence for the remaining 62% of homes is $548,252.

The annual net benefit of instituting universal pool fencing is $41,293,688. The cost savings per case prevented is $333,014.

Drowning-associated lifetime costs are enormous in Texas. Instituting a statewide universal pool fencing program will result in significant long-term savings.

1. Discuss the characteristics of functional swimming pool fencing.
2. Identify barriers to instituting functional swimming pool fencing in Texas.
3. Compute the economic benefit of a universal swimming pool fencing program in Texas.

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Barbara DiGirolamo, M.Ed., CPSTI

Pedestrian injuries, including by children going to school, are an important national safety issue. For children getting off a school bus, Massachusetts state law mandates cars must stop and can’t pass a school bus when it is stopped with the stop sign out as it is dropping children off. In one Massachusetts city, multiple cars were observed violating this law. However, the current Massachusetts law requires police to physically see each driver who is passing the bus to issue a citation for this offense. As a result, incidents have occurred where siblings were hit by a car, a crossing guard and student on bike were hit while on the crosswalk during a red light, as well as multiple daily “near misses.” The objective of this program description is to describe an advocacy program, which advanced passage of a law to improve the safety of children walking from school buses with the installation of cameras on buses to record motor vehicles violating the law mandating them to stop when a school bus is stopped for student drop-off.

This child pedestrian safety program was focused on gathering data on motor vehicle violations related to school buses and on advancing legislation to install cameras on school buses to decrease the risk of child pedestrian injury when leaving the school bus. A Safety Task Force in the city was convened, which was overseen by the Mayor and included parents, school staff, local police, injury prevention experts, and the health board. Activities of the Safety Task Force included: 1) speaking to students in local schools about pedestrian safety; 2) distributing an informational newsletter for parents; 3) attending local events and fairs to get signatures in support of the law change; and 4) obtaining broad media coverage from local news channels. The Safety Task Force also obtained a grant to install bus cameras to record motor vehicles passing stopped buses to obtain data and evidence about these violations.

In September 2024, there were 10 cameras added to the city’s 33 bus fleet. From September 2024- May 2025, over 3,000 cars were recorded passing stopped school buses dropping off children for school, for an estimated 10,000 violations. Since the law stated police have to witness these violations in person, these individuals couldn’t be ticketed. However, this evidence was then used with legislators to advocate for changes in the state law. In January 2025 the Massachusetts Governor signed into law, legislation allowing any city or town to install cameras on school buses, and use these video recordings to mail citations directly to the vehicle owners driving past stopped school buses.

Passing a new child safety law in a state is challenging, and often, takes years of work. Partnering with allied organizations, including AAA, Safe Routes to School, Injury Free, Safe Kids, and ThinkFirst are great ways to leverage your argument. Partnerships, evidence, and advocacy are essential for policy changes to improve child pedestrian safety.

1. Describe strategies for working with your government to pass better laws protecting our youth.
2. Analyze approached to obtain data and evidence to support your proposed law changes
3. Examine how to build partnerships with other community organizations, police and elected officials to gain support in your proposed initiatives

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Jeannette M. Joly, MD
Krysta M. Sutyak, DO
Neil G. Jayarajan, BS
Amber Rollins, BS
Janette Fennell, BBA
KuoJen Tsao, MD
Kevin P. Lally, MD, MS
Natalie A. Drucker, MD, MS

Pedestrian collision with a motorized vehicle-in-reverse is referred to as backover trauma. Resulting injuries carry significant morbidity and mortality, and they disproportionally occur in small children due to challenging visualization. For prevention, a federal mandate was passed on May 1, 2018 requiring all new vehicles to be equipped with a backup camera; however, older vehicles may still lack this safety feature. This study aims to characterize the impact of this mandate by evaluating the rate and severity of pediatric backover trauma before and after its enactment.

A retrospective pre-post observational study was conducted of patients less than 5 years of age with backover trauma between January 2011 and November 2024. Two sets of data were compared: electronic medical records of patients treated at a level one pediatric trauma center as identified by the institutional trauma registry, and data curated by Kids and Car Safety from publicly available injury records of the surrounding metropolitan counties to externally validate institutional trends. Trauma registry abstraction included demographics, injury severity score (ISS), hospital course, and disposition. Severe injury in pediatric trauma was defined as ISS >25. Backover trauma rates and severity were compared pre-mandate (01/2011-04/2018) versus post-mandate (05/2018-11/2024). Descriptive statistics, univariate analyses, and Poisson rate tests were utilized.

From trauma center data, 71 patients were identified: 53 (75%) pre-mandate, 18 (25%) post-mandate. Patients were a median age of 2 years (IQR: 1.6-2.8), 61% male, and 68% with governmental insurance. Overall median ISS was 10 (IQR: 5-19): no difference between groups (p=0.83). There were 10 cases of severe trauma pre-mandate (19%) versus 2 cases post-mandate (11%) (p=0.72), with one pre-mandate, in-hospital death. The trauma rate pre-mandate was significantly higher at approximately 7.2 backovers/year compared to 2.7 backovers/year post-mandate: a rate ratio of 0.38 (95% CI: 0.21-0.66; p<0.01). In public injury records, 23 victims were identified: 17 (74%) pre-mandate, 6 (26%) post-mandate. Injuries were reported fatal on scene or shortly after emergency medical service transport in 13 pre-mandate cases (76%) and 4 post-mandate cases (67%) (p=0.63). The trauma rate pre-mandate was higher at approximately 2.3 backovers/year compared to 0.9 backovers/year post-mandate: a rate ratio of 0.39 (95% CI: 0.13-1.05; p=0.06).

A decrease in the rate of backover trauma was observed following the 2018 federal mandate requiring backup cameras in all new vehicles. Severe injuries decreased by half, and the absolute number of publicly reported fatal cases decreased by 69%. Reduction in rate and severity of backover trauma justify public health-driven regulatory requirements. Post-manufacturing installation of backup cameras should be prioritized and subsidized for all vehicles manufactured prior to the 2018 federal mandate.

After listening to this presentation, the listener will be able to:
(1) Define backover trauma in pediatric patients
(2) Describe the impact of federally mandated backup cameras on pediatric backover injuries
(3) Summarize next steps for prevention, which include supporting a subsidized program to install backup cameras in cars without them

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Melissa Kwan, MD, FAAP
Marisol Nieves, LMSW, CPST
Sarah Beth Abbott, BS, EMT-LP
Zuha Khan, BS
Sandra McKay, MD, FAAP

Drowning is the second leading cause of death for children ages 1-4 years old and the second leading cause of unintentional death for children ages 5-14 years old. To address this, we partnered with the local community hospital, medical school, and community organizations to develop an interactive drowning prevention program for caregivers and children in a suburb of a large metropolitan area.

Planning meetings started 12 months prior to this event. A grant from the state AAP chapter foundation provided the initial funding. We worked with our local community hospital, the YMCA, and two local drowning prevention foundations for initial planning and coordination. Other community partners were also invited to provide their expertise the day of the event.

Activity stations were designed so volunteers could set up with a prepackaged kit. A passport was developed to encourage families to stop at each booth.

Volunteers were recruited through the medical school and community hospital. Advertising was managed by the hospital’s marketing department.

The day opened with the local drowning prevention foundation sharing their stories about how drowning has affected their lives and education. Families then went to activity stations staffed by our volunteers with a focus on safe rescue and personalized education.

100 individuals registered, 53 participants attended, and there were 41 volunteers. Pre- and post-surveys showed 90% of respondents reported having an open body of water within 10 minutes walking distance from their home. After the event, all respondents reported feeling confident that they could identify things in their home or nearby that might be dangerous for their child around water. Prior to the event, only 55% could report this. After this event 75% reported knowing where to find help to make their home safer and prevent drowning. Overall, 55% reported not having enough money to pay for changes at home to keep their children safe from drowning. Most respondents reported that their income was over $75k annually. A three-month post-event survey is pending.

Developing a successful community event is a collaborative effort. Verbal feedback revealed that caretakers think their children are getting drowning prevention education in swim lessons, but the adults were not. While this is a gap that we can fill with similar events, this is also an opportunity for swim instructors and schools.

90% of respondents lived within 10 minutes walking distance of a body of water that they did not have the ability to change or implement safety measures. This is a gap that can be filled through working with our communities who manage these bodies of water.

For future events, we plan to extend the invitation to more community partners. The activity stations were created with the intention to be reused with instructions so volunteers could set up with minimal interventions, so this initial investment can be used again.

1. Describe how to develop and fund a successful educational program within a larger community event.
2. Examine funding sources and partnerships to help make an event successful.
3. Identify how a program like this can be replicated in other arenas.