Crisis in the Water: Bringing Awareness to Drowning Prevention

Drowning is the leading cause of deaths in children ages one to four, other than birth defects. It is the second leading cause of death in teenagers, according to the

.

WVLT News anchor Brittany Tarwater has spent the last year working with families who have lost children and loved ones to drowning who all have had the same questions. Why isn't the number one killer of babies a conversation pediatricians are having with parents at every well-child visit? Why aren't there strict swimming guidelines every parent knows about? Thanks to the relentless efforts by families, especially one in East Tennessee, now there are.

Nicole and Jonathan Hughes are plagued by the paralyzing pain of losing their son Levi.

"Levi was our third child and our final one, we were very certain, we had two girls and a boy. He was such a boy too," said Nicole.

Her three-year-old son looked forward to their family's favorite week of the year, an annual beach trim with five other families to Alabama.

"We had pictures around the house and Levi would say, "mom are we going to the beach soon?"

Every time she knew her kids would be around water, she protected them with proper gear.

"Everything they did that day Levi was wearing a puddle jumper or a life jacket. He's flying a kite, he's wearing a life jacket, eating M&M's he's wearing a puddle jumper. We really thought we were doing everything right when it came to water safety," said Nicole.

With seemingly no reason to keep it on, Levi's puddle jumper was off during dinner inside the house.

"We were eating dinner and cleaning up and we really weren't doing anything," said Hughes. "I saw a plate of brownies so I split a brownie with him and put it in his bowl and then I turned away. I turned and he somehow got out the door and I didn't' even know he was missing that's how fast it happened. Oh my gosh, it was so quick I walked out and out of instinct I looked out and over the balcony."

Levi was in the pool.

"I wasn't expecting to see anything I don't know why I looked and there he was and I just saw this bright flash of yellow. It was the shirt I just put on him 30 minutes before," she said.

In seconds he was gone.

"To leave for vacation with your family and have to drive back without your son, there's really just not words," said Nicole.

That same day, on the other side of the country, another family going home without their baby. Olympic skier Bode Miller and his wife Morgan's daughter Emeline, just a year and half old, drowned in their California neighbor's pool.

Like Levi, Emmy also was not expected to be in the pool. In seconds she was gone.

"Every time I close my eyes at night to go to sleep it replays in my head," said Morgan. "It happens so fast and under normal, every day circumstances where life happens the way it has for years and it's forever changed our families lives."

The same pain that ripped their hearts apart is also bringing these two families together.

The Hughes and the Millers started working together to bring drowning to the front of the national conversation.

"We are failing them, our culture is failing them," said Nicole. "I wrote this plea to the American Academy of Pediatrics, saying please let me help. It was summer and kids were dying every day."

The AAP joined the fight with the two families and created new public service announcements to let other parents know about the importance of water safety.

"We can raise a lot of awareness and things like that but we want to have impact in the long run, we want to make sure the action steps can be accomplished," said Bode.

The Hughes and the Millers also teamed up with chair of AAP Council on Injury, Violence and Poison Prevention, Dr. Ben Hoffman, to re-write

that hadn't been updated in nearly 10 years.

"It is a public health crisis. We're talking about 12 kids a week who drown in the US. The standard American school bus holds 70 kids so we're talking about nine plus school buses over the course of a year. If there was an infectious disease that was killing nine school buses of kids a year we would think of it as a public health crisis and it is. We need to re-frame the way we think of it. It's just not acceptable for kids to be drowning at these rates," said Hoffman.

Hughes has said her pediatrician never talked about drowning dangers, and never asked if any of her three children knew how to swim. The

released in May recommends that pediatricians have safe swimming conversations with parents at every well-child visit. But, as Dr. Hoffman has pointed out, it is not a requirement.

"We write policy which helps inform best practices but we can't tell members what to do," he said. "It's not perfect but my hope is that today more pediatricians are talking about it than were a year ago and we're not going to stop until we get those numbers up and up and up and up."

The policy also suggests children as young as one start swim lessons, the youngest the AAP has ever recommended. Research shows children who take consistent, formal lessons are 88 percent less likely to die from drowning.

"What is the real factor that would have made a difference? I think Its if I would have put him in swim lessons," said Nicole. "People sort of lump it together with soccer and dance lessons and it's not, it can not be in the same category it is not just an extra curricular to give your kids something to do. This is life and death."

Within weeks of Levi's death, his parents started

, spreading the word about water safety. It encourages families to appoint a water guardian even when children are not swimming, but have access to water.

Drowning doesn't happen like most people imagine. There is rarely splashing and yelling for help. it's silent and can happen in a matter of seconds. The

reports an average of ten people die from drowning every day, a quarter of them are children. Most child drownings happen like Deborah Blizzard's two-year-old granddaughter Brooklynn, in a backyard pool.

"It was the worst day. I was at work. My daughter, Holly and her came home and they were out playing. Brooklynn wanted to go swimming," said Blizzard.

Brooklynn didn't know how to swim. She was told to wait until after a nap to go in the water. Brooklynn unlocked two deadbolts while her mother was sleeping to get to the pool.

"She was underneath the float," she said.

Brooklynn died that day last summer.

"We miss her so much. But I know she's watching us."

Blizzard started

to bring awareness to water safety.

Like Brooklynn, the AAP reports nearly 70 percent of drownings happen when children aren't expected to be in the water. Not just swimming pools, all it takes is a few inches of water.

"I personally have seen kids who have drowned in buckets, toilets, little plastic wading pools in the back yard. I've seen kids drown in bathtubs when the parents got up to answer a phone call. A child in water, a child around water is always a risk," said Dr. Hoffman.

Knowing the truth about safe swimming products will provide an extra layer to keeping children protected in the water. Blow-up swim wings and inflatable rings are not United States Coast Guard approved safety devices. Amanda Roland, aquatics director for YMCA of East Tennessee said they easily deflate and kids can take them off.

"If you can blow it up with your mouth it's a toy," said Roland "The more safe products are the Coast Guard approved products life jackets, puddle jumpers. If they say U.S. Coast Guard approved they're made of foam and they fasten so they're hard to take off."

All products should be worn correctly to best protect children.

Though they are U.S. Coast Guard approved, there is some debate about children wearing puddle jumpers in a pool. Some experts like Camilla Hephner swim instructor and owner of Swim 'N Float, worry about an unsafe up and down body position puddle jumpers create in the water and said they can cause a false sense of swimming ability.

"They think that they can swim. And it's fun. They swim around in their puddle jumper and they think I'm going to jump in, I'm going to float in a vertical position and I'm going to swim around the pool and when they jump in without their puddle jumper that's not what happens," said Hephner.

Nothing can drown-proof a child, but there are layers of protection the AAP recommends to be proactive:

Always wear a life jacket on the open water, but don't rely on flotation devices for protection.

Check for four-sided fences around pools with latches that lock high enough to be out of reach of children.

Pool alarms are required by law in Tennessee in pools built since 2011. There are alarms to monitor movement that stay in the pool and alarms that go off when a door opens.

Don't store toys in the pool, they can tempt young children to jump in.

Swim lessons are proven to make children nearly 90 percent less likely to drown.

Nothing replaces supervision. Designate a water guardian who knows CPR (

) . That person should never, even for a moment, leave children unattended around water.

Dry drowning or secondary drowning is a popular topic among parents, especially on social media. It refers to children sputtering and coughing on water while swimming, then after seeming fine, later "drown". Dr. Ryan Redman, medical director of the emergency department at East Tennessee Children's Hospital said the way dry drowning is presented in these platforms is not true.

"The way that it's presented in those forms is generally just not accurate. The idea that someone can have an episode where they're swimming and it was largely uneventful and then suddenly have severe symptoms is just something that we don't see. There are instances where you can have aspiration events where you do choke, cough, sputter, get some water in your lungs and it can progress but that's generally something that we always can identify and is something that isn't necessarily surprising," said Dr. Redman.

Dr. Ben Hoffman with the American Academy of Pediatrics also said dry drowning is a myth.

"I think the most important thing for people to know about dry drowning is that it's not a thing. Dry drowning does not happen, it is a myth. If a child has suffered an injury from a submersion event, so having gone under water, it's going to be apparent at that moment, when they get out of the pool. If something happens 24 hours later, it's not because of that submersion event. Dry drowning is just not a thing," said Hoffman.

If there is a concern after swimming, look out for nausea, vomiting, fever, or persistent coughing. If these signs are present, call a medical provider.

East Tennessee Children's Hospital reports an average of 50 children treated per year for serious drowning events. Drownings that are serious but not deadly can cause severe brain damage that can lead to long term problems, learning disabilities and even permanent loss of basic functions.

While most young children and babies drown in pools, teenagers are most at risk in the open water. The AAP claims drowning as the second leading cause of death in teenagers behind only car crashes. John Whited, deputy chief of Knox County Rescue Squad has blamed overestimating their skills and underestimating danger.

"Open water you have boat traffic that you have to be aware of, underwater hazards you have to be aware of, rocks, trees, stumps, things that you can get hung up on," he said.

Earlier this summer Alexis Shirley, 13, died when she drowned at Peery's Mill Dam.

Last summer Nelson Chilel-Ramirez, 16, drowned trying to save Kaleigh Ramirez, 15, who also drowned on Cherokee Lake.

In 2017 Joshua Armon Davis, 18, fell off a boat in Fort Loudon Lake. He drowned just days before he was set to graduate from Farragut High School.

"People get out and swim beyond their ability and without some sort of personal flotation device you can get in trouble really quick. There might be an event that you cant control, you might get a cramp that can cause you to drown," said Whited.

Whited said open water conditions and currents change, view is limited and often times things on water appear much closer than they are. Understanding water safety limits applies to everyone.

The American Academy of Pediatrics has called drowning a public health crisis, but there are some people who are more likely to die from drowning than others.

"We see that there is a huge racial disparity," said Dr. Hoffman.

Drowning does not discriminate, but there are some who are at a higher risk. According to

, African Americans and Hispanics are three times more likely to die from drowning than whites.

64% of African Americans have little to no swimming ability

45% of Hispanics have little to no swimming ability

40% of Caucasians have little to no swimming ability

80% of drowning victims are males

USA Swimming also notes that parents who don't know how to swim are far less likely to teach their children how to swim.

"You add that on top of the access issues and the fact that swimming lessons require a pool which is not something that's always found in lower socioeconomic communities, the fact that swimming lessons often have cost associated with them, the fact that we've seen a real change in parks and recreation programs int he last 20 years in that they're much less available in that they're much less available and much less robust in terms of what they offer so a lot of these kids don't have the opportunity to learn how to swim and if you don't know how to swim then you can't protect yourself in the water," said Dr. Hoffman.

There are options in East Tennessee for swim lessons from private businesses and non-profit organizations.

Infant Swimming Resource (ISR) is also referred to as survival or self-rescue swim lessons. ISR typically begins lessons when a child is as young as six months old, submerges a child under water and teaches a repetitive movement of flipping over to float on their back and wait for rescue until they do it by instinct. Once the child has mastered the movement, they are tested wearing clothes and shoes to be prepared for a situation where they are not expected to be swimming. Critics of the technique say it can cause stress on the child but advocates say it keeps young children safe. It typically takes six weeks of daily lessons for a young child to learn this technique.

Traditional swim lessons can begin as young as six months old. It focuses on gaining confidence in the water before submersion. It teaches fundamental techniques to children like floating on their backs and fronts, blowing bubbles and kicking at a pace that challenges the child, while matching their comfort level. These lessons are intended to teach basic swimming techniques that eventually lead to learning strokes.

Both options are available in East Tennessee. Continuous lessons make a child 88 percent less likely to drown, according to USA Swimming. The AAP reports no research proving lessons under one year old are effective but experts like SafeSplash Swim School general manager and instructor Emily Jacobssen have recommended children start lessons as young as six months to avoid developing a fear of the water.

"They can start as early as six months and we found starting them that early makes them feel comfortable in the water and we can also eliminate any kind of fears that they may have developed as they get older," said Jacobssen.

is East Tennessee's first year-round, indoor swim school. It was opened by Knoxville native and Olympic gold medalist Davis Tarwater. It follows a more traditional lessons model, with curriculum endorsed by USA Swimming. Its mission is to create a fun and trauma-free environment for swimmers with highly trained instructors teaching new swimmers, children with special needs and even adults.

Camilla Hephner is a certified ISR instructor. She started

in her Knoxville backyard pool six years ago. In addition to the ISR method, when children are old enough to walk, Hephner teaches the child to float on their back and kick to the wall for safety.

Jenna Johnson is a University of Tennessee graduate, former Lady Volunteer swimmer and Olympic gold and silver medalist. She offers year-round lessons to children of all ages and ability through

and coaches in the Knoxville and Maryville-Alcoa areas.

Nearly 80 percent of children in households with incomes less than $50,000 have little to no swimming ability, according to USA Swimming, but there are affordable solutions in East Tennessee.

USA Swimming's philanthropic branch is called the

. It's mission is to teach every child water safety by giving groups across the country funding for swim lessons.

Some of that money has supported the

. Their lifeguards teach children starting at five years old who are members swim lessons all year long for free.

"It's really important for our kiddos to know how to safe when they are around water, we want to keep them safe first and foremost and we want them to be able to protect themselves if they get into a sticky situation," said Regal Teen Center club director Chara Morris.

has grants for families who qualify for free or reduced cost swim lessons for children of all ages. It partners with Centro Hispano and Bridge Refugee to teach swim lessons even to people who don't speak English.

"We're trying to be that resource and be that source of knowledge for them. Even if there is a language barrier we are able to get translators through those organizations so that way they can come and learn how to swim and learn how to be safe," said aquatics director, Amanda Roland.

targets urban families living in Knoxville. It charges five dollars per week for one-on-one lessons with Red Cross certified instructors.

"The thing about this community is that there really aren't a lot of pools around so the kids in this community, they don't see a pool, they don't think about swim lessons and then in the summer when they go to the lake or an outdoor pool they think, i don't know how to swim. And so what we're really trying to do is let people know that this pool is here and we offer private lessons here, we offer group lessons here and we would really love for everyone in this community to learn how to swim," said aquatics ministry director, Marlee Sanders.

Olympic swimmers and coaches representing team USA tell their personal stories about why water safety is important.

12 x Olympic medalist Natalie Coughlin talks water safety.

Olympic silver medalist and first black US Olympic swimmer Maritza Correia McClendon talks water safety.

2 x Olympic silver medalist and former Lady Vol Christine Magnuson talks water safety.

Olympic gold medalists Elizabeth Beisel and Maya Dirado talk water safety.

4 x Olympic medalist Peter Vanderkaay talks water safety.

Olympic gold medalist Melanie Margalis talks water safety.

Olympic gold medalist Davis Tarwater talks water safety.

Olympic gold and silver medalist and former Lady Vol Jenna Johnson talks water safety.

Olympic coach David Marsh talks water safety.

2016 Olympian and former Lady Vol Molly Hannis talks water safety.

2012 Olympian Clark Burckle talks water safety.

Olympian Kate Ziegler talks water safety.

Olympic silver medalist Connor Jaeger talks water safety.

*Some competitive teams also offer swim lessons.

For a list of summer league teams and seasonal swim lessons in the Greater Knoxville Area Interclub Swimming Association (GKAISA), click

.