The overall prognosis for children who sustain a submersion incident is directly related to several variables including length of submersion, initial neurologic evaluation, time to first breath, initial pH, and others. Resuscitation after near-drowning is unsuccessful in terms of death and neurologic deficit in 30% of those children who are treated at our institution. Despite the fact that we have been able to present variables that are somewhat predictive of outcome, it is almost impossible to identify 100% of the time which particular comatose child will survive neurologically intact. Therefore skilled attempts at resuscitation and management are mandatory. The understanding of the sequence of events that occur during the drowning process and the pathophysiologic consequence make it possible for health care personnel to provide aggressive therapeutic interventions that will enhance the likelihood of a normal recovery.