Background and aims: Drowning is a preventable catastrophic injury death with a high reported incidence challenging the community in general and pediatricians in particular. Aims: The aim of the study was to assess the magnitude of the problem among children in the community, the outcome and the factors critical for prevention of this injury. Methods: This retrospective study was performed at PICU, Maternity & Children Hospital, Madina Almunawara, Saudi Arabia.The IRB void the need for consent as this was an observational study. 20 cases of pediatric drowning admitted to PICU over a period of five years were reviewed and multiple variables including on-site and in- hospital evaluated that were paramount in affecting the outcome. Results: Out of 20 patients admitted to the PICU, 8 (40%) were direct admission to the hospital ER; 4 (20%) were discharged neurologically intact, 7 (35%) were discharged in a vegetative state and 9 (45 %) died. Duration of submersion and on-site CPR were statistically significant with a p-value of 0.001 and 0.005 respectively. Only in one case resuscitation was done on site by a formally trained by-stander. Glasgow Coma Scale, pH and temperature upon hospital arrival were found to be prognostically significant. Conclusions: These results emphasize our concern about adherence to swimming pool safety rules, to improve public and by-stander basic life support education, justification in aggressive ER resuscitation measures depending on important factors like a GCS or pH and regionalized registry of these cases to assess the magnitude of the problem and strive for solution.