More than 2000 children drown each year; in some states drowning is considered the leading cause of death for children under the age of 5 years. Many survivors of near-drowning have permanent neurologic disability. There are two distinct high risk groups: children under 5 years of age and boys aged 15 to 19 years. Most drownings in the former group occur in residential pools. Among survivors, the clinical course is bimodal; intact survival and survival with severe permanent disability are the most likely outcomes. The outcome of an immersion event is determined within a few minutes of the onset of immersion, mandating an emphasis on primary prevention. A requirement for pool fencing is the most promising such strategy and could be implemented soon. Training in cardiopulmonary resuscitation and (for older children) alcohol abuse prevention programs may be valuable adjuncts.