There was a media blitz on “dry drowning” last summer, just about this time, on a topic that is stirring up angst and worry among parents again this year. There’s good reason it makes parents nervous – drowning at baseline is a preventable tragedy that is terrifying to think on– and it’s the leading cause of accidental death to children between age 1 to 4 years, and the second leading cause of accidental death in those between 5 and 14 years. Everyone is scared of it for good reason. But “dry drowning” (a submersion injury that happens in a different way from what most of us think about when we think about children drowning) sends people through the roof, in part because of misunderstandings. And the language, and the misleading nature to it all.
What Is “Dry Drowning?”
The term in itself is a bit confusing (and a little controversial among doctors — most emergency room doctors and pediatricians don’t want to use the term AT ALL). Pediatricians prefer and recommend referring to both dry and secondary drowning as “submersion injuries”. Drowning is drowning — but drowning, in and of itself, doesn’t mean death, it means exposure to water, by submersion, and injury from it. Technically speaking, as I understand best how parents and media talk about it, dry drowning is when a small amount of water causes spasms in the airway and the soft tissues in the airway (epiglottis, larynx) thus causing the airway to close up and make breathing very difficult. This is rare – but would happen within a few minutes of water entering the mouth and throat and being pushed back towards the airway, instigating spasm. This happens immediately after exiting the water. The spasm can be very dangerous and typically would cause sputtering or coughing or choking. This is an immediate reaction to water entering the airway.
Secondary drowning, as some call it, is when water gets into lungs and causes inflammation or swelling inside the lungs, making it difficult or impossible to transfer oxygen effectively to the rest of the body. Water can enter the lungs in small amounts even 24 hours before showing signs of increasing distress as inflammation builds. The injury from a submersion injury like this wouldn’t happen out of the blue. This distress and inflammation would happen over time with coughing, feeling or acting ill, distress, coughing again, vomiting, or difficulties in doing regular activities.
Most important, thankfully, is these two unusual submersion injuries, are exceedingly rare, only representing 1-2% of drowning deaths.
Let me be clear with a scenario here….you take your child to the pool, they go under the water for a few seconds and pop up sputtering and maybe coughing a bit. They appear normal in all aspects within seconds (talking, breathing, eating, alertness, giggling, playing, etc.) and you go home. They eat a normal meal and head to bed without any cough or trouble. Your child is not going to suddenly die in their sleep from “dry drowning” without a single symptom. It just doesn’t physiologically happen this way. It’s where the term feels like it’s a scary lurking monster. And submersion injuries aren’t like that. With a submersion injury to the lung, a child would typically show signs of lung irritation, fatigue, coughing, and trouble breathing first. If at any time your child does that, of course call your pediatrician or head in immediately if you’re concerned after swimming.
What Parents Need To Know:No question submersion injuries are preventable. Supervision is always our 1st line of defense! Just being present, not walking away, not allowing distractions (cell phone, alcohol, sleep, etc) will always be the best line of defense, especially with young children or new swimmers. Always closely watch children near or in water. Any tiny pool of water is a risk, especially for toddlers. Make sure lifeguards are present when children are at pools. If you don’t feel lifeguards are doing their job – speak up! Learn what to do if you spot a child you think is drowning. Learn CPR for infants and children, too. Teach your child how to swim. Start as early as 1 years of age or younger if your infant is ready to be in the water with you. Data supports that children over age 1 have some protective benefits from swim lessons. Although swim lessons will not prevent all drowning, it will help children be safer around water as they age. Never use swimming lessons as a reason to leave children alone. In my mind, no one should ever swim alone. Put your child in a U.S. Coast Guard-approved life jacket when playing in or near the water, on a dock or in a boat, raft or inner tube. Supervision and a life jacket are two of the most important things you can provide to protect your child from drowning.
Symptoms Of Submersion Injuries Or “Dry Drowning:”Persistent coughing and/or increased “work of breathing” after swimming Sleepiness out of proportion after swimming Forgetfulness or change in behavior, in context of other changes after swimming Throwing up (a sign of stress, and sometimes from inflammation in lungs)
For all children pulled from the water for concern of injury:Call pediatrician or 911 even if you think they are ok (no hurt in checking in with them) Monitor for 24 hours after submersion
Some Data To Keep Drowning In Perspective:Children ages 1 to 4 have the highest drowning rates. They DEMAND constant, in arm’s reach supervision. Immersion-related drownings are preventable and you being around and watching changes the game! 91% of deaths were associated with lack of direct supervisor 82% of deaths were 4 years or younger 70% occurred at home (this means home pools, hot tubs, bath tubs, kiddie pools, etc.)
Resources:Swim Safety Tips (American Academy of Pediatrics Seattle Children’s Hospital – Drowning Prevention Parents Magazine Article On Dry Drowning Live Science Article On Dry Drowning American Red Cross On Dry Drowning
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