Unintentional fatal child drowning in the bath: A 12-year Australian review (2002-2014).

Aim: To establish the prevalence of unintentional fatal drowning in baths involving children <18 years in Australia and to identify causal factors to underpin prevention.

Methods: We report a total population study of all childhood (0-17 years) unintentional drowning fatalities in baths (bathtubs, spa baths and showers) in Australia between 1 July 2002 and 30 June 2014. Demographic, forensic and aetiological data (including co-bathing, use of bath aids, supervision and enactment of cardiopulmonary resuscitation) were documented for each victim.

Results: Seventy-eight children were identified; two thirds (66.7%) were under 2 years old, of which 43.6% were aged less than 1 year (1.0/100 000/annum) and 23.1% 1-2 years (0.27/100 000/annum). Nine older children (10-17 years) also drowned. Common causes included: infants and children unable to hold their head out of water while unsupervised and associated pre-existing medical conditions, including epilepsy. All children who drowned were left without adult supervision. No child drowned in a bath with water deeper than 40 cm (M = 19.4 cm). Custodian-reported 'time left unsupervised' ranged from 30 s to 60 min. Children with pre-existing medical conditions were, on average, older (9.9 years; confidence interval: 7.9-11.9) and left unsupervised for longer (M = 15.4 min; confidence interval: 3.8-27.1) than those without.

Conclusions: On average, 6.5 children drown every year in baths in Australia. Children aged younger than 1 year are most affected, with both genders equally represented. Infants and toddlers left unsupervised, false confidence in the preventive role of bath aids, unrealistic expectations in the supervisory capabilities of co-bathing children and epilepsy remain threats to children in the bath.