It's terrifying that a child can seem fine after getting out of the water, but start to have trouble breathing an hour—or even 24 hours—later. But you'll worry a lot less once you know the signs of dry drowning and how to prevent it from happening.

By Elena Donovan Mauer
Updated April 21, 2021
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Kids Splashing In Pool
Credit: sakkmesterke/Shutterstock

You've probably read scary stories on social media about "dry drowning" or "secondary drowning." They're essentially non-medical terms referring to delayed symptoms experienced after submersion in water. Dry drowning can lead to dangerous respiratory distress in kids, but it can be prevented with the proper precautions. Here's what you need to know before your next swimming session.

What is Dry Drowning?

The terms "dry drowning" and "secondary drowning" (medically known as submersion injuries) are often used interchangeably—even by some experts—but they're actually different conditions, says Mark R. Zonfrillo, M.D., MSCE, attending physician in the Department of Emergency Medicine at the Children's Hospital of Philadelphia.

Dry Drowning: Someone takes in a small amount of water through their nose and/or mouth, and it causes a spasm that makes the airway close up. Dry drowning usually happens soon after exiting the water.

Secondary drowning: A little bit of water gets into the lungs, resulting in inflammation or swelling. The body subsequently struggles to transfer oxygen to carbon dioxide and vice versa. With secondary drowning, there can be a delay of up to 24 hours before the person shows signs of distress. 

Some experts reject the terms "dry drowning" and "secondary drowning" altogether, and simply refer to them as submersion injuries. Dr. Zonfrillo says they're equally dangerous, as both can cause trouble breathing and, in worst-case scenarios, death.

How Common Is Dry Drowning? 

Rest assured: Submersion injuries, while incredibly scary, are rare. There aren't specific stats on how many kids die each year from dry drowning or secondary drowning, but it's very few, says Kathleen Berchelmann, M.D., a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine. 

In fact, in 12 years practicing as a pediatrician, Dr. Berchelmann has only seen one patient who suffered from drowning that happened long after getting out of the pool. Still, she says, it was a life-threatening scenario, and if you're going to be spending time at the pool, ocean, or lake this summer, it's smart to know the signs and symptoms.

Signs of Dry Drowning

The good news: "You're going to see warning signs," says Sarah Denny, M.D. a member of the American Academy of Pediatrics' Council on Injury, Violence & Poison Prevention, and an attending physician in the Section of Emergency Medicine at Nationwide Children's Hospital in Columbus, Ohio.

Look out for these dry drowning symptoms in toddlers, babies, and children:

Water rescue. "Any child pulled from the pool needs medical attention," says Dr. Berchelmann. "At the very least, call the pediatrician."

Increased "work of breathing." According to Dr. Denny, rapid and shallow breathing or nostril flaring means your child is working harder to breathe than normal—and so does seeing the space between the child's ribs or the gap above their collarbone when they breathe. If you notice these symptoms, you should seek medical help immediately.

Coughing. Persistent coughing—or coughing associated with increased work of breathing—needs to be evaluated.

Sleepiness. Was your kid just playing excitedly in the pool, and now they're acting fatigued? It could mean they aren't getting enough oxygen into their blood. Don't put them to bed until their doctor gives you the go-ahead.

Forgetfulness or change in behavior. Similarly, a dip in oxygen level could make your child feel sick or woozy.

Throwing up. "Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, and also from persistent coughing and gagging," explains Dr. Berchelmann.

If you think your child might have a submersion injury, whether you're in your backyard pool or on a beach vacation, call the pediatrician immediately. They should talk you through symptoms, says Dr. Berchelmann, and might advise you to visit the ER, a primary care doctor, or a national urgent care center.

If your child is really struggling to breathe, though, call 911 and/or head to the emergency room right away. "Necessary treatment may not be available in settings other than the ER," says Dr. Zonfrillo.

Dry Drowning Treatment

Treatment for submersion injury depends on the severity of the patient's symptoms, says Dr. Denny. The doctor will check your child's vital signs, oxygen level, and work of breathing. Patients with mild symptoms might simply need careful observation, while in more serious cases, the doctor may perform a chest X-ray or give them oxygen.

In cases of respiratory failure, which happens when a child can no longer breath on their own, extra support is required—such as intubating them or putting them on a ventilator. The goal is increasing blood flow in their lungs and getting the child breathing well again. (Thankfully, though, respiratory failure is rare with dry drowning.)

How to Prevent Dry Drowning

To prevent dry drowning and secondary drowning—as well as other water-related injuries—consider these expert-approved strategies. 

Enroll your child in swim lessons. Kids who can skillfully navigate the water are less likely to struggle. 

Supervise kids near water. Monitor kids closely whenever they're around water. Also make sure to enforce pool safety rules.

Follow water safety measures. Children should wear floatation devices on boats; pools should have four-sided fencing around them; and you should never leave a child alone near standing water. 

As long as you practice water safety, pay close attention to your kids after swimming, and get them checked out if you notice trouble breathing, you shouldn't stress about dry drowning or secondary drowning (submersion injuries). "I can't emphasize enough how rare they are," says Dr. Zonfrillo. And for any parent, we know that's welcome news.