Records of 95 childhood drowning and near-drowning victims hospitalized between 1981 and 1987 were reviewed. Reactions of 14 nurses, 27 physicians, and 13 social workers to 4 case scenarios were solicited. Only eight drownings were reported to Child Protection Services (CPS). Reporting was significantly more likely if the child was younger or nonwhite, the family was poor, the injury was in the bathtub, social work was involved, a prior CPS report was on file, or consideration of neglect was documented in the chart. Reporting was not related to the child's sex or clinical outcome, the parent's marital status or drug/alcohol history, type of child supervision, or time until discovery or history of prior accidents. Only 28 percent of the cases received social-service evaluation. Intensive care staff were least likely and emergency room staff most likely to consider drowning scenarios neglectful. Profession, age, sex, years in practice, and whether or not one was a parent did not affect the referral decision. Judgment that scenarios were neglectful correlated closely with the decision to report. Lapse in supervision by an intoxicated father was thought to be most neglectful. Judgment was split as to whether or not poor families who let infants bathe alone or with siblings were neglectful or lacked sufficient knowledge of hazards and infant development. A 4-year-old who wandered into a lake at a picnic was judged to be the victim of an unfortunate accident. Clinicians found decisions about referral stressful. Drowning cases should have social service evaluation and aid. As with every injury, clinicians should diagnose and treat both the injury and etiology. Only a select few will require CPS referral. 3 tables and 16 references