Table 2.

Recommendations and sources of the evidence for preventing drowning

Recommendations	Guidelines and/or institutions recommending the intervention	Source of the evidence
Installation of a four-sided isolation pool fencing With self–closing and self–latching gates, around backyard swimming pools. Pool fences should completely separate the house and play area from the pool.	- WHO 2008; European region [1] - WHO 2017; global [41] - PrevInfad 2011 [42] - CDC 2019 [16] - EuroSafe 2006 [13]	- Thompson 1998; Cochrane systematic review [43] - Neto 2008, review [44]
Provide safe places away from water for pre-school children Removing or covering water hazards	- WHO 2008; European region [1] - WHO 2017; global [41] - RCPCH 2019 [2]	(See original documents)
Use of life jackets and personal flotation devices Make sure kids wear life jackets in and around natural bodies of water, such as lakes or the ocean, even if they know how to swim. Life jackets can be used in and around pools for weaker swimmers too.	- WHO 2008; European region [1] - CDC 2019 [16]	(See original documents)
Set and enforce safe boating, shipping and ferry regulations	- WHO 2017; global [41] - EuroSafe 2006 [13]	(See original documents)
Swimming Everyone should know the basics of swimming (floating, moving through the water)	- WHO 2008; European region [1] - WHO 2017; global [41] - CDC 2019 [16] - NICE 2010b [35] - EuroSafe 2006 [13]	(See original documents)
Close supervision at all times When kids are in or near water (including bathtubs). Because drowning happens quickly and quietly, adults watching kids in or near water should avoid distracting activities like playing cards, reading books, talking on the phone, and using alcohol or drugs.	- RCPCH 2019 [2] - CDC 2019 [16] - NICE 2010b [35]	- Kendrick 2012; Cochrane systematic review [45] - Epidemiological surveillance of drowning in France, 2015 [46]
Provide immediate resuscitation - Perform immediate cardiopulmonary resuscitation to drowning victims - Train and employ lifeguards at beaches and public swimming pools	- WHO 2008; European region [1] - WHO 2017; global [41] - RCPCH 2019 [2] - NICE 2010b [35] - EuroSafe 2006 [13]	(See original documents)

Abbreviations:CDC Centers for Disease Control and Prevention, NICE National Institute for Health and Care Excellence, PrevInfad PrevInfad workgroup from the Spanish Association of Primary Care Pediatrics, RCPCH Royal College of Paediatrics and Child Health, WHO World Health Organization