“Dry” drowning: info for parents
Every year as pool season approaches, questions about dry drowning come up: “Is this something I should worry about?” “How do I keep my child safe?”
Much of the information out there is sensationalist and confusing. Here is a simple overview of what you need to know.
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Drowning is a leading cause of childhood death. This post goes through the definition of drowning, what to watch for and when to call the doctor. Stay tuned for an upcoming post on evidence-based ways to keep your children safe and prevent drowning.
Terminology
The terminology of drowning is extremely confusing. Terms like “dry drowning”, “near drowning”, “delayed drowning” and “secondary drowning” are often used interchangeably and are ambiguous. In fact, because they are confusing, using these terms is actively discouraged by organizations such as WHO, CDC, and Red Cross. I’ll go through how drowning is actually defined below.
Water can be fun, but also dangerous
Drowning is a leading cause of childhood death, especially in infants and toddlers.
The highest incidence occurs among males, African Americans, children between 1-5 years, and in the summer.
There is also a second peak of these types of incidents amongst males between ages 15-25 years, which highlights the importance of teaching and reinforcing water safety even as your children age.
Taking water safety seriously is absolutely critical, and the data shows that MULTIPLE LAYERS of safety are the best way to prevent drowning. Stay tuned for an upcoming post on this.
What is drowning?
Drowning happens when submersion in water causes respiratory impairment.
Fatal drowning occurs when that type of submersion event leads to death.
Non-fatal drowning with injury is what happens when a submersion event does not lead to death but causes some type of injury (eg acute lung injury, disabilities, etc).
Non-fatal drowning without injury is what happens when a submersion injury thankfully results in no problem. This last category is often called a “near-drowning” event in the media which is an inaccurate description and leads to more confusion with terminology.
Where does “dry drowning” come from?
A classic news article about dry drowning will describe an alarming story: a child coughed/choked while swimming, aspirated water, but then remained “absolutely fine.” Hours later, the child died.
This scenario plays into every parent’s fear - the inability to protect our kids. After all, children will often cough/sputter/swallow water while swimming, and seem okay. The idea that this seemingly normal minor event might go on to lead to death without any other signs is terrifying.
Let me reassure you: this is an extremely unlikely scenario.
Submersion /drowning can cause injury in a few different ways.
Sometimes choking causes laryngospasm - spasming of the vocal cords - which then closes off the airway. The term “dry” may be used in this context because the spasm is preventing water from getting into the lungs (so the injury is not technically caused by water).
Sometimes aspirated water gets into the lungs, causing inflammation that can take sometime to build up.
And finally, sometimes a submersion event will lead to decreased oxygen flow to various parts of the body, eg. the brain or the heart, and cause serious injuries.
In ALL these cases, a person will develop some symptoms/red flags as the process evolves, so if a parent knows what to watch for and is able to seek medical care, this shouldn’t be a worry.
Possible scenarios
There are four possible scenarios to keep in mind:
A child who is rescued and has lost consciousness. They obviously need CPR and ongoing medical evaluation/care.
A child who is rescued from the water, has not lost consciousness, but does not seem normal. They may be confused, have color change, develop vomiting, coughing, or shortness of breath. These children need immediate medical attention as well.
A child who is playing in water, seems to aspirate/cough/swallow it, but still seems playful and has no immediate difficulty breathing. Over the next 2-12 hours, you may continue to hear intermittent coughing, or they may show more signs that they are struggling to breathe. They may also become suddenly more sleepy/tired, feverish, or just seem “off”.
What is challenging about this scenario is that being overtired from swimming (or overheated after a day in the sun), can cause some of the same symptoms. And of course, children often also have viral syndromes or other illnesses even when they’re on vacation. So it can be tempting to dismiss these symptoms.
A child who is playing in water, coughs and sputters and then returns to normal with no symptoms and no breathing difficulty. They have no cough, their energy is baseline, and over the next hours/day they continue to have ZERO symptoms whatsoever and remain energetic and playful.
The stories of “dry drowning” in the media are not discussing children in scenario 4. They are discussing children in scenarios 2 or 3, who really do need to be evaluated.
The Pediatrician Mom Tip: Many parents fear taking their child in and being labeled as “that” parent who overreacts. It can be tempting to dismiss intermittent coughing or other symptoms after your child has a submersion episode. The truth is, if you get an evaluation and your child is deemed fine to monitor at home, that’s a best case scenario, not a waste of time. It is never wrong to seek advice from a healthcare professional.
When to call the pediatrician
This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!
Some red flags include:
increased work of breathing (see my instagram reel on this which walks you through exactly what to watch for and how to identify these signs of respiratory distress: grunting, nasal flaring, retractions, rapid breathing). I will also have a post soon on normal respiratory rates and how to count vitals.
Coughing
Skin color change
Headaches, dizziness
Fever
Foaming at the mouth
Vomiting
Chest pain
Change in appetite
Looking/acting sick, more tired/sleepy, or altered mental status (eg confusion)
The bottom line here: if your child has some type of submersion event, EVEN if it seemed mild, this is still considered drowning. Whether it is nonfatal drowning with non injury, or nonfatal drowning with some injury can be hard to tell at first.
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