In this nationwide cohort study, we analyzed over 2000 drowning cases involving children under 17 years of age across 13 years, with 9% resulting in death. The study revealed significant variations in drowning rates by age, sex, and region. This is the first study in Israel to examine pediatric drowning over such an extended period, including all cases regardless of mortality, providing a comprehensive epidemiological overview.

The 9% mortality rate highlights the ongoing public health challenge of pediatric drowning, reflecting global trends of persistent drowning risks among children [20]. The recent increase in drowning rates observed in our study indicates an urgent need for improved preventive strategies, as current measures may have reached a plateau in effectiveness [21]. Our findings offer crucial insights for developing targeted prevention strategies and may serve as a model for similar studies and interventions worldwide.

Our study found that drowning incidents peaked in the summer, likely due to increased water-related activities, consistent with findings from Banihani et al. [22] and Loux et al. [23], who reported higher drowning rates in the United States and Florida during warm months. However, mortality rates were higher in colder seasons, such as winter and spring, possibly due to more hazardous conditions and reduced lifeguard presence. To reduce drowning risks throughout the year, recommendations include public education on water safety, improved lifeguard training, environmental modifications, community programs, and technological interventions like AI surveillance and wearable detection devices [24, 25].

The most severe drowning incidents often result in immediate death at the scene, while those who reach the emergency room (ER) show that severity, as indicated by longer hospital or ICU stays, correlates with higher mortality rates. Our study found that children hospitalized for 3 days or less had a 7% mortality rate, whereas those hospitalized for 4 or more days had a 39% mortality rate, consistent with other studies suggesting that prolonged stays indicate more severe conditions [26]. These findings underscore the importance of rapid emergency responses, including effective CPR by caregivers and bystanders [27, 28] and highlight the role of advanced inhospital resuscitation techniques, such as extracorporeal life support (ECLS), in improving survival rates, as evidenced by data from the National Trauma Data Bank and the Extracorporeal Life Support Organization [30, 31].

Our study identified a bimodal distribution in age-specific drowning rates, with peaks in children aged 1–4 and a smaller peak in teenagers aged 15–17. This pattern, along with the male predominance observed in nearly 60% of drowning cases reported by Benihani et al. [22] and higher hospitalization rates for males found by the Center for Injury Research and Policy [32], reflects broader trends linked to risk-taking behaviors and substance use [33,34,35,36,37]. To address these disparities, we recommend targeted education programs, enhanced supervision, and promoting safety measures such as life jackets and drowning detection devices. Ongoing research is essential to evaluate these interventions’ effectiveness.

Despite the high risk of drowning among adolescents, our study and findings by Peden et al. reveal a significant lack of targeted prevention strategies for this group, with no studies evaluating effective interventions [38]. This gap is concerning given adolescents’ unique risk factors, such as increased risk-taking behaviors, peer influence, and limited supervision. To address this, comprehensive, evidence-based strategies are needed, including education on specific risks, safety measures in recreational areas, and community-based interventions involving adolescents and their families. Filling this gap is crucial for reducing drowning incidents and enhancing prevention efforts.

Our study reveals regional disparities in drowning incidences, likely influenced by cultural practices, geographic proximity to water bodies, and access to swimming education [39]. Drowning was less frequent in the Jerusalem and Judea districts, potentially due to their distance from water, as Wang et al. [40] found that over 70% of drowning incidents among children under 5 occurred within 100 m of water. In Israel, access to swimming education is limited by geographic and socioeconomic factors, especially in rural areas. Addressing these disparities requires investments in infrastructure, subsidized programs, community outreach, equitable policies, and collaboration with nongovernmental organizations (NGOs) to ensure better water safety across all communities.

Analysis of the past 13 years indicates an increase in drowning incidents, especially from 2020 to 2022. This aligns with findings by Benihani et al., who reported a rise in drowning-related injuries in 2021 following the onset of the COVID-19 pandemic [22]. During the pandemic, increased home water exposure, reduced supervision, and gaps in water safety education likely raised drowning risks [41, 44, 45]. Additionally, climate change may have extended swimming seasons and intensified weather conditions, contributing to these risks [42, 43]. Addressing these trends requires a multifaceted approach, including public education, environmental safety measures, and targeted interventions for high-risk groups [46].

Trauma-related incidents, such as drowning, can cause severe, long-term neurological damage. A 2013 Helsinki study on 21 pediatric ICU drowning survivors found that at a median follow-up age of 12.5 years, 57% had neurological dysfunction, and 40% had intellectual impairments, with full-scale IQs below 80 [47]. These results underscore the need for early post-hospital assessment and long-term management of survivors, highlighting significant implications for healthcare systems. An integrated approach to preventing pediatric drowning is presented in Table 2.

Our study has limitations due to its retrospective design and multicenter approach, lacking detailed information on specific locations and activities, which limits targeted prevention recommendations. Variations in medical protocols across regions also affect data consistency. Despite these limitations, the national registry provides large-scale, population-wide data, enhancing generalizability and statistical power and allowing for longitudinal analysis of trends and health outcomes. While data from 2023 is not included, trends from 2010 to 2022 offer a solid foundation for adaptive drowning prevention strategies, allowing updates as new data emerge.

In conclusion, our study offers new insights into pediatric drowning by analyzing nationwide data over 13 years, revealing long-term trends and recent increases in incidents. We identified a bimodal age distribution with peaks in toddlers and teenagers, indicating the need for age-specific prevention strategies. Higher mortality rates in winter and spring highlight the importance of year-round safety campaigns, while regional disparities emphasize location-specific efforts. The link between prolonged hospitalization and higher mortality rates underscores the need for timely interventions. Our findings support a comprehensive prevention approach involving education, environmental safety, policies, and targeted strategies to enhance global drowning prevention efforts. Future research should focus on understanding the causes of recent increases in drowning incidents and developing targeted interventions to effectively mitigate these risks.