“Dry Drowning” info for parents
Every year as pool season approaches, the media starts to publish stories about “dry drowning” and pediatricians get asked: “Is this something I should worry about?” and “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. See my prior post for evidence-based ways to keep your children safe and prevent drowning.
Terminology
Part of the confusion is that the words used to describe drowning are ambiguous and used interchangeably (eg: “dry drowning”, “near drowning”, “delayed drowning” and “secondary drowning”). 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. See my prior post for my top tips to keep your child safe near water.
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. This is because if there was submersion and respiratory impairment, it is still technically a drowning event.
Where does “dry drowning” come from?
The classic news article about dry drowning will describe the following alarming story: a child coughed/choked while swimming, aspirated water, but then was “absolutely fine.” Hours or days later, the child died.
This scenario plays into every parent’s fear. 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 “dry drowning” articles are referring to the process where choking lead to 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 the water).
In another scenario, aspirated water can get into the lungs, and it causes inflammation and infection. This can take some time to build up, sometimes even a few days, and you will usually see gradually worsening respiratory symptoms and sometimes fever.
Finally, sometimes a submersion event will lead to decreased oxygen flow to various parts of the body, eg. the brain or the heart, which can have serious consequences.
In ALL these cases, the child will develop some symptoms/red flags as the process evolves. Which means if a parent knows what to watch for and is able to access medical care, this shouldn’t be a worry.
Possible scenarios
Here are four possible scenarios and tips for what to do:
A child who is rescued from the water 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, pale or blue, 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”. Sometimes the child will seem fine for a few days and then develop worsening cough, difficulty breathing, and fever.
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 so it is easy to dismiss them. And of course, these nonspecific symptoms can also be a sign of a viral illness — kids do get sick even when on vacation. But this third scenario is the one you where you want to be most thoughtful and not dismiss 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 typically not discussing children in scenario 4. They are describing children in scenarios 2 or 3, who absolutely do need to be evaluated.
The Pediatrician Mom Tip: You may be worried about overreacting or wasting your pediatrician’s time by going in for minor symptoms. I can assure you that as a pediatrician, I would much rather you came in and were told “all is good” than lay awake stressing at home. I don’t see that as a waste of my time, I see it as a best case scenario. 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 as I said: your pediatrician would rather you called!
Some red flags include the following. Most of these will occur within minutes to hours following the event, but some (such as fever) may not be seen until 24 - 48 hours later.
increased work of breathing (see my instagram reel on this which walks you through exactly what to watch for, with examples so you can easily identify common signs of respiratory distress such as grunting, nasal flaring, retractions, rapid breathing). I also have a free guide that covers how to assess vital signs and what is normal by age.
Coughing
Skin color change
Headaches, dizziness
Fever
Foaming at the mouth
Vomiting
Chest pain
Change in appetite
Looking/acting sick
Fatigue
Behavioral changes or confusion, acting “off”
Anything tickling your Spidey sense!
The bottom line: any submersion event that leads to respiratory symptoms is considered “drowning”. Whether it is nonfatal drowning with non-injury, or nonfatal drowning with some injury can be hard to tell at first, but your job is to watch your child closely through the subsequent few days.
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And more than anything, TRUST YOUR GUT, and get them checked out if you’re concerned at all.
Be sure to check out my prior post which goes over evidence-based ways to prevent drowning.
