Submersion injury in children.

After prevention, of all the elements in the care of the drowned child, none is more important than the early institution of respiration and appropriate resuscitation. Observation of the asymptomatic patient with any history of alteration of consciousness or respiration during a drowning accident for at least 12 to 24 hours is mandatory. Because of uncertainties regarding outcome, particularly in the presence of hypothermia, vigorous emergency department resuscitation of all drowning victims is advisable, regardless of presentation. However, it may prove that emergency department assessment of such patients, following successful cardiopulmonary resuscitation, is a prognostic indicator of great importance in dictating further care. Transfer of these severely injured patients to a pediatric referral center where intracranial pressure monitoring and intensive support are available offers the best hope. Provisions for psychosocial support and follow-up for family members are essential.