Objective To investigate the epidemiological characteristics and related influencing factors of fatal drowning in children and adolescents aged 0–17 years in Chongqing, thus providing evidence for the prevention and control of fatal drowning in this population.

Methods The Child Drowning Death Questionnaire designed by the Chronic Disease Center of Chinese Center for Disease Control and Prevention was adopted to collect case information of fatal drowning in children and adolescents aged 0–17 years in Chongqing, 2022 by medical history/death record review, telephone interviews, household surveys, and home visits. The investigation comprised three essential components: basic information, drowning death accident information, and drowning death accident investigation process information.

Results In 2022, the drowning mortality of children and adolescents aged 0–17 years in Chongqing was 3.36/100 000 (standardized mortality of 3.42/100 000). The drowning mortality was higher in boys (4.64/100 000) than in girls (1.93/100 000) and higher in rural areas (4.19/100 000) than in urban areas (1.09/100 000). It was the highest among adolescents aged 15–17 years (5.66/100 000). There were differences in the places of fatal drowning among children of different ages (χ² = 59.918, P < 0.001), with those over 10 years old mostly occurring in natural water bodies, and those under 10 years old primarily happening in public water storage areas. There was no significant difference (P > 0.05) in injury intention of fatal drowning among children of different sexes (χ² = 3.866) and ages (χ² = 7.021). Most (90.82%) of fatal drowning in children was unintentional, of which 4.26% were skilled swimmers; 0.53% took preventive measures; and 2.70% were effectively cared for (with an adult caregiver, uninterrupted care for nothing else and at arm′s length). On-site first aid mainly consisted of passers-by and adult caregivers, mainly cardiopulmonary resuscitation (CPR). However, the cases with time interval from drowning to CPR being ≤ 5 min only accounted for 6.76%.

Conclusions The drowning mortality is high among children and adolescents in Chongqing, and special attention should be paid to the prevention of drowning in boys and rural areas. Attention be focused on the investigation and management of dangerous waters in rural areas, the swimming skill and water safety education for children and adolescents, the nursing awareness and nursing skill training of adult caregivers, the application of intelligent monitoring system in key waters, and the popularization of first aid technology.