UNLABELLED: Pediatric drowning incidents, both fatal and non-fatal, represent a significant challenge in emergency medicine, particularly for children under 14 years of age. Drowning is a leading cause of unintentional injury-related deaths, with children aged one to four years being especially vulnerable. Accurate and timely assessment, particularly through chest imaging, such as chest radiography (CXR) and lung point-of-care ultrasound (LUS), is crucial for evaluating pulmonary complications and guiding treatment decisions. This retrospective study analyzed 64 pediatric drowning cases in Istituto Giannina Gaslini, Italy, from 2012 to 2023. For all patients, demographic data, vital parameters, blood tests upon PED admission and at 24 h, need for intensive care unit admission, length of stay, therapies administered, ventilatory support in the PED and in the hospital ward, and mortality were recorded. The patients were subsequently divided into two groups based on the chest X-ray result. The results indicated that pathological CXR findings upon admission were associated with a higher likelihood of hospital admission, prolonged hospital stay, and more severe clinical outcomes, including the need for oxygen supplementation and antibiotic therapy. Patients with abnormal CXR findings also exhibited lower oxygen saturation, Glasgow Coma Scale scores, and body temperature upon admission, reflecting a more significant physiological compromise, and higher RCP values at 24 h. CONCLUSION: Although the majority of non-fatal drowning patients recovered without lasting neurological deficits, the findings suggest that CXR plays a critical role in early management, assisting in the identification of those at greater risk for complications. WHAT IS KNOWN: • Fatal and non-fatal pediatric drowning incidents may represent a critical issue in pediatric emergency medicine, requiring prompt assessment and accurate management upon admission, even if standardized protocols are lacking. WHAT IS NEW: • Chest imaging in the initial assessment of pediatric drowning cases may serve as a fundamental tool to support early clinical decision-making, particularly when integrated with other key parameters such as neurological status, vital signs, and blood exams.