It sounds scary: A child can seem fine after getting out of a pool or body of water but then start to have trouble breathing an hour—or up to 24 hours—later. You'll worry a whole lot less once you know the signs and symptoms of submersion injuries, and how to prevent them.
Dry Drowning: Know the Signs
Chances are you've read scary warning stories about "dry drowning" or "secondary drowning"—terms you probably never even knew existed before you became a parent—on social media. These terms imply that your child could "drown" on dry land, which is not exactly the case. "Dry drowning" and "secondary drowning" are non-medical terms used to refer to delayed symptoms experienced after submersion in water. These submersion injuries and delayed respiratory impairments can be prevented. Get the facts you need to help keep your kids as safe as possible in and out of the water.
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.
In dry drowning, someone takes in a small amount of water through his or her nose and/or mouth, and it causes a spasm in the airway, causing it to close up. In secondary drowning, the little bit of water gets into the lungs and causes inflammation or swelling that makes it difficult or impossible for the body to transfer oxygen to carbon dioxide and vice versa. Dry drowning usually happens soon after exiting the water, but with secondary drowning, there can be a delay of up to 24 hours before the person shows signs of distress. Both can cause trouble breathing and, in worst-case scenarios, death.
More important than the difference between the two—Dr. Zonfrillo says they're both equally dangerous, and in fact, some experts reject the terms altogether, and simply refer to them not as forms of drowning, but as submersion injuries—is knowing how to prevent such submersion injuries, and identify when your child is having trouble breathing after a swim.
Is it common?
Rest assured: Submersion injuries, while incredibly scary, are rare, says Dr. Zonfrillo.
There are no specific stats on how many kids die each year from these types of submersion injuries, 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, she's 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 be aware of the signs and symptoms.
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How to spot dry drowning (submersion injury)
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.
No matter your child's age, be on the lookout for these signs and symptoms:
- Water rescue. "Any child pulled from the pool needs medical attention," says Dr. Berchelmann. "At the very least, call the pediatrician."
- Coughing. Persistent coughing or coughing associated with increased work of breathing needs to be evaluated.
- Increased "work of breathing." Rapid shallow breathing, nostril flaring, or where you can see between the child's ribs or the gap above their collarbone when they breathe, means they're working harder to breathe than normal, says Dr. Denny. This is a sign that you should seek medical help immediately.
- Sleepiness. Your kid was just excitedly playing in the pool, and now she's fatigued? It could mean not enough oxygen is getting into to her blood. Don't put her to bed until her doctor gives you the go-ahead.
- Forgetfulness or change in behavior. Similarly, a dip in oxygen level could cause your child to 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, also from persistent coughing and gagging," explains Dr. Berchelmann.
What to do
Any time you're concerned about your child and think he could have symptoms of a submersion injury, whether you're in your backyard pool or on a beach vacation, call the pediatrician right away for advice. Your child's doctor should be able to talk you through it, says Dr. Berchelmann, and might advise you to go to the ER, a primary care doctor, or a national urgent care center.
But if your child is really struggling to breathe, 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.
How it's treated
Treatment for submersion injury depends on the severity of the patient's symptoms, says Dr. Denny. The doctor will check the child's vital signs, oxygen level, and work of breathing. Patients with more mild symptoms just need careful observation, in more serious cases, the doctor may also do a chest x-ray or give him oxygen. In cases of respiratory failure, or when a child can no longer breath on their own, extra support is needed—such as intubating or putting the child on a ventilator—but that's very rare. The goal will be to increase blood flow in the lungs and get the child breathing well again.
How to prevent it
Prevention is the same for dry drowning and secondary drowning (submersion injuries) as it is for any other kind of drowning or water injury:
- Swim lessons. Kids who are comfortable and skilled at moving around in the water are less likely to go under and take in water. Children can safely take swim lessons as early as age 1, according to the American Association of Pediatrics.
- Supervision. Monitor kids closely in and around the water, and enforce pool safety rules.
- Water safety measures. Children should wear floatation devices on boats; pools should have four-sided fencing around them; and you should never leave standing water where a child could get into it.
As long as you practice water safety, pay close attention to your kids after swimming, and get them checked out if you notice any signs of trouble breathing, you shouldn't have to constantly stress about dry drowning or secondary drowning (submersion injuries). "I can't emphasize enough how rare they are," says Dr. Zonfrillo. Heading into vacation season, that's welcome news.