Drowning

A child can drown in a few centimetres of water - be it a puddle, bath or fish pond.

It can happen in minutes and without the child even making a sound. Sometimes a moment away to answer the phone while your child is in the bath is all it takes.

For every child who drowns there are five who suffer permanent brain damage from the lack of oxygen during the few minutes they couldn't breathe - just four minutes without oxygen is enough to cause irreversible damage, Nick Dollman of Netcare 911 says.

If a child is drowning or lying or floating face-down in water, do this immediately

1. Get to the child in the water
If possible get the child out of the pool, dam, river, lake, fish pond or bath immediately. But don't try to rescue someone from the ocean if it means endangering your life - rather call for help and try to reach the child from land using a pole or rope.

Tie yourself to something secure on shore if you have to swim to the child. If the girl (or boy) is still breathing but you suspect a spinal cord injury from a dive into the water, keep them as still as possible.

Keep them lying face up in the water and call loudly until help arrives. Use a surfboard or something similar as a stretcher to keep the child's neck and back immobilised. Don't turn the head sideways without turning the whole body as well.

Don't twist the neck in any direction - if handled incorrectly the spinal cord could snap, resulting in paralysis.

2. Check for responsiveness
Tap the child's shoulder and ask if she's okay. If she doesn't move or make a sound shout for help and ask someone to call an ambulance. Don't leave her; lie her on her back on a flat, hard surface.

3. Clear the airway
Quickly remove any seaweed or other objects from the child's mouth to help her breathe. To open the airway lift the chin with one hand while pushing down on the forehead with the other.

4. Check for breathing
Check whether the child's chest rises and falls. If possible kneel and place your ear against her nose to listen for breathing sounds. See if you can feel a breath on your cheek. If the child isn't breathing she needs cardiopulmonary resuscitation (CPR) immediately. You can attempt mouth-to-mouth resuscitation while still in the water if the situation allows. Every second counts - the clock is ticking towards the four minutes that could result in permanent brain damage.

CPR for a child between one and eight years old

• Pinch the child's nose shut, lift up her chin, inhale deeply and, with your mouth over her mouth, exhale steadily in two slow breaths (not one large, forceful breath). Each breath should last one second.
• Between breaths, lift your head and see if her chest falls. If it doesn't, adjust the child's head and try again.
• If you've given two breaths and she doesn't breathe, cough or move, start chest compressions.
• Kneel beside the child. Place the heel of one hand on the breastbone between the nipples.
• Put your other hand on the child's forehead, keeping the head tilted back.
• Lean over the child and, with your arms straight, press down to a third or half the depth of the chest.
• Give 30 chest compressions at almost two compressions a second - a rate of 100 a minute is ideal.
• Then give two slow breaths as described above.
• Repeat 30 chest compressions and two breaths.
• Continue with CPR until help arrives or the person takes a spontaneous breath or starts to move. If you're alone with the child give two minutes of CPR before calling for help.

Never dive in head first if you don't know exactly how deep the water is and what's going on beneath the surface.

CPR for a child younger than one year old
There should be two differences in your approach:

1. Cover the infant's mouth as well as nose with your mouth to create an airtight seal. Give two breaths.
2. Position only your third and fourth fingers in the centre of the chest just below the level of the nipples. Press down to a third or half the depth of the chest.

Did you know?
Any person who has narrowly escaped drowning is still in danger - secondary drowning due to fluid in the lungs may be fatal. Always take them to hospital.

What next?

• If the child is breathing but unconscious with no spinal injuries, place them in the recovery position - with the head tilted back slightly and the arms and legs positioned to prevent her from rolling on to her back or face.

• Keep the child warm.
• All near-drowning victims should spend 24 hours in hospital for observation.

Tips:

• If there's someone to help you let them take over CPR duties as soon as you get tired.
• Don't worry about broken bones or ribs; they'll heal. The risk of delaying CPR or not doing it at all is far greater.
• Even if you're not doing CPR perfectly, don't stop - it's better to do it poorly than not at all.
• If CPR is started within four minutes of collapse the child has a real chance of survival.

Numbers to call in an emergency

• Netcare 911: 082-911
• ER 24: 084-124
• State ambulance and fire department: 101-77
• All state emergency services: phone 112 from your cellphone