If you’re like most parents, you probably figure once your child is done swimming or playing in the water, their risk of drowning is over. But each year, an estimated 40 to 80 children (about 1 to 2 percent of all annual drownings) in the U.S. alone die from “dry drowning”, a phenomenon in which a person–usually a child–drowns on dry land, long after they’ve left the water. Here’s what you need to know to keep your family safe this summer:
WHAT IS DRY DROWNING?
“Dry drowning” and “secondary drowning” (also called submersion injuries) are considered atypical types of drowning in that they occur after a child has left the water. Though the terms are often used interchangeably, they’re actually different conditions.
Dry drowning occurs when a small amount of water is inhaled through the nose and/or mouth but does not reach the lungs. It does, however, enter the airway and irritate the larynx, or vocal chords, causing them to close up and restrict breathing. This event, called a laryngospasm, can also occur during surgery, when people are on anesthetics such as ketamine. While the airflow is blocked, the heart continues to pump. This lack of oxygen-rich blood leads to hypoxia and acidosis – both of which can lead to death.
With secondary drowning, a swimmer inhales water, either due to a near-drowning incident or sudden rush of water — as might happen when jumping from a high surface or exiting a water slide. Unlike dry drowning, secondary drowning is characterized by a small amount of water entering the lungs. The swimmer often appears fine immediately after the event. But over time, water left in the swimmer’s lungs builds up and causes severe irritation and inflammation, triggering a response that pushes even more fluid into the lungs. The end result is a condition called pulmonary edema. If untreated, the person will eventually stop breathing and drown in their own body fluids.
WHO IS MOST AT RISK?
Both dry and secondary drowning can happen in adults, but like drowning in general, young children are at the greatest risk due to their small size (and smaller airways). Additionally, children are less likely to be strong swimmers and thus are more vulnerable to accidental water inhalation.
WHERE DOES IT HAPPEN?
Secondary and dry drowning can occur anywhere with water, including swimming pools, the ocean and even the bathtub. It doesn’t take much water to produce a potentially fatal response once it enters the lungs: for a 50-pound child, just three ounces of water is enough to impair lung function, rendering them unable to deliver oxygen to the bloodstream. However, it’s not just the amount of water that matters, but also what’s in the water.
“Depending on what’s in the fluid, it can have numerous effects on the lung,” Dr. Stephen Epstein, a spokesman for the American College of Emergency Physicians, told ABC News. “One of the things that keeps the breathing bubbles in your lungs — alveoli — open is a chemical called surfactant, which can get diluted [when fluid enters the lungs].”
As a result, the body reacts by sending in other fluids to help and flooding your lungs. The component in the fluid likely responsible for diluting the surfactant? Chlorine. So for this reason, children may be more likely to suffer from secondary drowning after inhaling water from swimming pools, as opposed to other types of water. Inhaling pool water can also cause chemical pneumonitis, or inflammation of the lungs due to harmful chemicals. There is also some evidence that suggests that children who inhale saltwater, rather than freshwater, may be more likely to die from secondary drowning.
WHAT SIGNS SHOULD I LOOK OUT FOR?
Symptoms of dry drowning usually happen right after any incident in the water. Secondary drowning generally starts later, sometimes up to 24 to 72 hours of the incident.
Dry drowning and secondary drowning have the same symptoms. They include:
- Coughing and/or wheezing
- Chest pain
- Trouble breathing
Children may also have changes in behavior such as such as irritability or a drop in energy levels, which could mean the brain isn’t getting enough oxygen.
HOW CAN IT BE PREVENTED?
It goes without saying that you should be closely supervising your kids at the pool or ocean, but even if you’re watching them like a hawk, kids will be kids. Since the precipitating event may not necessarily look especially dramatic — say, a toddler slips under water for a few seconds — it’s especially critical that parents pay attention to how their child responds after. If you see them come out of the water coughing, keep an eye on them and be prepared to seek medical attention.
Kids who are coughing and spluttering for more than a minute or two after getting out of the water and/or who have foam around the mouth need to be taken to an emergency room immediately. Additionally, anyone who was submerged in water and came up struggling — especially if he or she had to be retrieved from the water by a lifeguard, parent, or other bystander — needs emergency medical evaluation. Most of the time, children in these situations will be observed for 4 to 6 hours before being released, while some may need to be put on oxygen for a day or two, until their surfactant regenerates. But in serious cases, patients can go downhill quickly and must be put on a respirator to prevent death or brain damage.
Of course, the key to avoiding a dry or secondary drowning incident is to prevent a near-drowning experience from happening in the first place. Hence, prevention is the same for dry drowning and secondary drowning as it is for any other kind of drowning:
- Swim lessons. Kids who are comfortable and skilled at moving around in the water are less likely to go under and take in water. Around age 4 is a good time to start.
- 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. And adults should always avoid alcohol while swimming, boating, or engaging in any other water-related activities.