"Dry" Drowning Is Never Dry
- lifeslittleswimmers
- May 28
- 9 min read
Many parents worry about the risk of dry drowning in their children, so I want to alleviate some of those concerns. I'll conclude this post with water safety tips and a link to an in-depth chart for recognizing the signs of drowning. I hope this resource assists you in keeping your kids safe in the pool, open water, and even the bathtub.
You know there is an issue when professionals and medical providers are learning medical terms from social media, and not the other way around. A few summers ago, I read about dry drowning for the first time on Facebook. Since then, this misrepresented drowning condition has struck fear into the hearts of parents across the country. Any report that a child died from dry drowning then raises concern over this confusing topic and the questions start making the rounds through social parenting circles again. Since it’s now the time of year for swimming, I’d like to address these questions here.
About “Dry” Drowning
I get asked regularly about dry drowning. Parents are sometimes a little hesitant to voice their concern, but their questions about symptoms usually go like this:
“I think my son might have swallowed some water while in the tub last night, should I be concerned about dry drowning? I was so scared to put him to bed.”
“A few days ago, my daughter was playing the pool and coughed a few times after jumping in the water. She said she got water up her nose. Is dry drowning a possibility?”
The situations these parents are describing happen to all children at some point! It's extremely normal for a child playing in the water to experience swallowing or even inhaling some water, but parents are worried there is a greater danger and their children are experiencing symptoms of dry drowning. I understand those fears. There are many, many legitimate concerns and threats to protect our children from, but thankfully, dry drowning isn't one of them, and it doesn't have to keep you up at night.
Dr. Katherine Hensley summarized the feelings of the entire pediatric community when she said this,
“In short, your child is not going to go swimming, swallow some water, have no issues in the water whatsoever, and then suddenly die without warning 4 days later from “dry drowning”. I know the stories you’ve been reading, and I know how the thought of losing your child makes you have actual physical chest pain because it does that to me too. But I don’t want the kids of the world never going near the water again because their parents were frightened by a poorly researched Facebook article."
Remember that there is a lot of fake news and misinformation on the internet. Many authors do not care about delivering accurate, useful information. They care about the sensational headline. My major issues with the stories I’ve been reading lately are these: first, their misuse of the word “swallowing” when they mean aspiration. Second, their lack of discussion about REAL symptoms of actual drowning that parents should be watching for. Far too many kids die from drowning every year and it would be wonderful if the press would talk to some medical experts and get better information about drowning prevention out there to parents. Most of the stories I’ve read, however, give parents the impression that kids who have drowning with morbidity (the accepted medical term, check out the link below) swallowed some water, were fine for a few days and then suddenly died. It doesn’t really work like that. Drowning symptoms are much more dramatic.
Here’s the deal, in brief: a human may experience inflammation in the lungs (pneumonitis) with massive fluid production and death after aspirating water. This is not the same thing as swallowing water and many people don’t understand the difference. Swallowed water goes into the esophagus and down through the digestive tract. Swallowing overly-chlorinated pool water may make you throw up but it will not make you die of flash pulmonary edema. ASPIRATION is when the water goes past the epiglottis into the trachea and down into the lungs. In this case, the patient in question will have an episode of distress after they come out (or are pulled out) of the water. You will see it and you will KNOW they are not OK. They will take longer to recover than they would after choking on a little orange juice at the dinner table. They will cough and gasp and sputter. They may even require intervention like CPR. And I’m pretty sure everyone understands that a child who is down in the water, gets pulled out, and requires resuscitation needs immediate medical attention, even if they seem to recover. If your child has an episode like this and then later continues to have coughing, vomiting, wheezing, chest or belly pain, or seems abnormally tired, we have a problem. Get to the ED. If your child goes swimming and does not have an aspiration event and afterwards they are perfectly fine . . . they are perfectly fine. Go ahead and go to the beach this weekend, people.
The key to preventing drowning? Supervision. There needs to be a designated child watcher. Just because there are ten adults present doesn’t mean one of them is paying attention to the kids. Have a plan. If it’s a party where you don’t really know anyone, this is not the time to make new friends. Watch your kids. If you’re watching them and they have an aspiration event, you will see it and you will get them the medical attention they need. If your child is participating in swimming activities when they are not with you, be the annoying parent. Ask questions about who will be supervising. Ask if anyone present has had lifeguard training. If you don’t like the answers you get, don’t send your kid. Hosting a pool party yourself this summer? Consider hiring a lifeguard.
Dry drowning is not an accepted medical condition. Neither is near-drowning or secondary drowning. In fact, most health and medical organizations discourage the use of these terms entirely because of their confusing nature. People are hearing about dry drowning on social media.
Then what is drowning?
For the sake of simplifying the true medical terminology, drowning is… drowning. The official definition of drowning is “the process of experiencing respiratory impairment from submersion/immersion in liquid.” It's important to understand, though, that drowning can have three different outcomes. Drowning can result in:
* Fatal drowning (death is caused by drowning)
* Nonfatal drowning with injury or illness (patient survives drowning but has some type of
bodily damage)
* Nonfatal drowning without injury or illness (patient survives without bodily damage)
Instead of associating drowning immediately with death, the medical community looks at drowning as a spectrum, ranging from mild damage to death.
What is meant by dry drowning?
So, what are the supposed dry drowning symptoms you should look for? Because dry drowning has never been an accepted medical term, it's challenging to describe what has been largely influenced by different media sources. Dry drowning was previously used to describe the lungs of drowning victims that contained no water during autopsy. This happens in 10-20% of drowning cases, and may be related to laryngospasm, which is an uncontrolled or involuntary muscular contraction of the vocal folds. The condition typically lasts less than 60 seconds, but in some cases can last 20–30 minutes and causes a partial blocking of breathing in, while breathing out remains easier. Laryngospasms are often a symptom of an underlying condition, such as asthma, gastroesophageal reflux disease (GERD), or vocal cord dysfunction. However, we know that very little water actually enters the lungs during most drownings (usually less than 2mL/kg, for reference that's less than one ounce in a child who weighs 33lbs).
So, this is what parents need to remember: in drowning situations, the main medical problem is lack of oxygen to the brain. Whether there’s water in the lungs or no water in the lungs at the time of drowning, the problem is still lack of oxygen to the brain. The wet versus dry terminology is irrelevant, and because it doesn't change the treatment, drowning specialists no longer use these distinctions.
Dry drowning has also been used interchangeably with secondary drowning. Secondary drowning is not a medically accepted term, either, but it carries a fearful connotation for many parents that children can inhale a small amount of water and die days later. Biologically, this concept revolves around a disease process called pneumonitis. When children aspirate (inhale) water, it can disrupt the surfactant lining of the lungs. Sometimes this can trigger inflammation and fluid build-up in the lungs.
The take-home message I want parents to know about so-called secondary drowning symptoms is this: it is very rare. You don't have to be overly fearful of "missing" pneumonitis in your child. You won't accidentally overlook it. This isn't a situation where you feel guilty because your kid fell down, looked fine, and you waited too long to get an x-ray of their unknowingly broken arm. Children experiencing pneumonitis will have clear, worsening symptoms, including coughing, wheezing, inability to catch their breath, vomiting, extreme fatigue, and disorientation.
As Dr. Seth Hawkins said in his highly informative review on dry drowning,
“There has never been a case published in the medical literature of a patient who received a clinical assessment, was initially without symptoms, and who later deteriorated and died. People who have drowned and have minimal symptoms will either get better or worse within two to three hours.”
If your child has a drowning episode, go immediately to the ER (please skip your pediatric office or urgent care, they will just send you to the ER, too, so you don’t need an extra medical bill or wasted time!). Any coughing episode that lasts longer than several minutes following your child being immersed under water deserves medical evaluation. After an unconscious or involuntary prolonged immersion under water (if you ever have to pull your child from the water), it’s not optional to get them medically examined, even if they are not showing signs of trauma or trouble.
But let's not allow the confusion caused by dry drowning to distract us from the real enemy that drowning is to our children. Drowning is the leading preventable cause of death in children ages 1-4 years old, and this statistic has skyrocketed with the increased use of flotation devices. For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.
Obviously, as a society we need to ditch the puddle jumpers and water wings and all wearable floaties, because they give children a false sense of security and encourage them to get into the water unattended. Not to mention, they teach children to doggy paddle around in the vertical (drowning) position and this is the muscle memory that kicks in when incidents happen. Approved life jackets are designed for wearing out of the water and preventing in-water accidents – saving a life – not for swimming in.
WATER SAFETY TIPS TO PREVENT DROWNING
1. Watch children around water. Always. Constant undistracted supervision is key to drowning prevention. Don’t even think about bringing your phone while on watching duty, but keep it nearby in case of an emergency. Be within arm's reach of toddlers, this is known as touch supervision, and it is critical. Use a buddy system with older skilled children and never let them swim alone under any circumstances.
2. Every child needs to be taught how to swim. Please give them lessons as early as possible (around 6 months for survival swim programs) from a certified instructor to teach them to swim, grab the side and float on their back for a breath, and give them a refresher at the beginning of each summer for a few seasons. Private lessons are such a better value than groups. (See value chart here.) Also, contrary to popular ideas, don’t teach your baby or toddler to blow bubbles in the water. The natural instinct from a fall is to catch one’s breath. You don’t want them to let go of any oxygen once they hit the water, so that they will have the best chance of holding their breath and staying near the air. Older children may be taught to blow bubbles through their nose only to make swimming easier. You may do this by encouraging them to take a deep breath, put their mouth in the water, and then hum their favorite song with their lips tight.
3. Learn CPR. If your child is invited to a pool party, ask if there will be an adult there who knows CPR and a dedicated water watcher.
4. Please, please throw away your children's floaties of every sort. I cringe inside when I see little children wearing them. They are way too easy for children to remove themselves (or have another child do it) and floaties falsely instill confidence in children and parents. If you really must use a flotation device with your child, use a Coast Guard-approved life jacket ONLY since they are designed to roll an unconscious person on their back to be able to breathe.
One last thing. If you are unsure about any symptoms your child is experiencing, or you are concerned about the information you've read in an article, never be afraid to consult your pediatric provider. Now that you know that you don’t have to be concerned about dry drowning, you can focus on real drowning prevention and have fun swimming with your kids this summer.
Credit to notoutofthewater.com, kidnurse.org, infantaquatics.com, and ndpa.org
Comentários