WHEN IS CHILDHOOD DROWNING NEGLECT

Concern that drowning is frequently considered neglectful and referred to Children's Protective Services (CPS) led us to review the frequency and associations of referral. Records of 95 childhood drowning and near drowning victims hospitalized between 1981 and 1987 were reviewed. Reactions of 14 nurses, 27 physicians, and 13 social workers to 4 case scenarios were solicited. Only 8 drownings were reported to CPS. Reporting was significantly more likely if the child was younger or nonwhite, the family poor, the injury in the bathtub, social work involved, a prior CPS report recognized or consideration of neglect documented in the chart. Reporting was not related to the child's sex or clinical outcome, the parent's marital status or drug/alcohol history, type of child supervision, or time until discovery or history of prior accidents. Only 28% of the cases had social service evaluation. Intensive care staff were least likely and emergency room staff most likely to consider drowning scenarios neglectful. Profession, age, sex, years in practice and whether one was a parent did not affect the referral decision. Judgment that scenarios were neglectful correlated closely with the decision to report. Lapse in supervision by an intoxicated father, was thought most neglectful. Judgment was split whether poor families letting infants bathe alone or with siblings were neglectful or the result of poor knowledge of hazard and infant development. A 4-year-old who wandered into a lake at a picnic was felt a victim of an unfortunate accident. Clinicians found decisions about referral stressful. Drowning cases should have social service evaluation and aid. As with every injury, clinicians should diagnose and treat both the injury and etiology. Only a select few will require CPS referral.