Conclusion: Indications for effectiveness
This evidence statement is based on the systematic review by Thomson and Rivara (Cochrane Library), last updated in october 2006. The reviews on this topic of the American Academy of Pediatrics (Weiss et al, 2010) and the Harborview Injury Prevention & Research Center
(http://depts.washington.edu/hiprc/practices/topic/drowning/fencing.html) were also taken into account.
This review of Thomson et al., based on three studies, concludes that there are indications that pool fencing can significantly reduce the risk of drowning. Summary odds ratio for the risk of drowning and near drowning in a fenced pool compared to an unfenced pool is 0.27 (0.16-0.47). Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and pool) because perimeter fencing allows access to the pool area through the house. Odds ratio for the risk of drowning in a pool with isolation fencing compared to a pool with perimeter fencing is 0.17 (0.07-0.44).
Based on a study of general child safety barriers (Engdahl et al, 2009) we conclude that children's ability to climb fences varies with different types of fence. In an experimental setting Engdahl et al. concluded that simple barriers of heights 1.1-1.2 metres can be climbed by half of 4-6 year olds. The most effective barrier in this study is the one which is inclined towards the climber.
Recommendations (for research & practice)
Practice and Policy
Pool fences should have a dynamic and secure gate and should isolate the pool from the house (that is, four-sided fencing) (Thomson et al, 2006).
It is highly recommended that carers be strongly encouraged to continue close supervision of their children around pools; no protection system can replace parent supervision. Children's ability to climb fences varies with different types of fence; eg. the height of the fence is an important aspect.
Creating and maintaining surveillance databases of drownings are essential in order to evaluate the effectiveness of fencing type. These databases should include near-drownings, fencing types and regulations.
Review Date: 20/09/2011
Articles (reviews) and reports were included that were published between 1984 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute. Only one relevant article, dating from 1985, was found.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the autumn of 2010.
Pool fencing for preventing drowning in children (version 1.0)
D.C. Thompson, F.P. Rivara (2002)
Child Safety Good Practice Guide : good investments in unintential child injury prevention and safety promotion (version 1)
M. MacKay, J. Vincenten, M. Brussoni, L. Towner ...[et al.] (2006)
Child safety barriers (version 1.0)
Ann-Sofie Engdahl, Patrik Spånglund, Erica Waller (2009)
Technical report : prevention of drowning (version 1.0)
Jeffrey Weiss (2010)