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What Every Parent Needs to Know About “Dry Drowning”

Swimming with your child in the ocean for the first time is a memorable experience. I’ll never forget my son’s first dip; his wide eyes as the waves came to a crest and crashed up against him, his excited giggles as he splashed around in the salt water. But I’ll also never forget how I worried for the rest of that day and night about the water he accidentally swallowed.

That summer, it seemed like all I saw while scrolling through Facebook were articles about “secondary drowning” — a reportedly rare but potentially fatal occurrence where a person (often a child) inhales water while swimming, but doesn’t experience symptoms of drowning until hours or even days later, when it might be too late.

It’s a terrifying prospect for any parent. So when my son took those unintentional gulps and then began coughing, I became alarmed. He continued to cough a bit on the way home from the beach and intermittently all afternoon. By bedtime, the cough had pretty much subsided, but I had not stopped worrying about whether it was a normal reaction to getting a wave in the face or an initial sign of this strange and scary condition I’d been warned about so much on the Internet. I set alarms on my phone to wake me up every two hours so I could check to see if he’d developed additional symptoms overnight.

Fortunately, he was fine.

But now there’s another form of drowning that has parents in a panic. Earlier this summer, news broke that a 4-year-old boy from Texas died suddenly a week after inhaling water while swimming on a family vacation. Since then, there’s been a frenzy of information hitting the media about his suspected cause of death, a condition called, “dry drowning.”

According to WebMD, dry drowning occurs when water never reaches the lungs. “Instead, breathing in water causes your child’s vocal cords to spasm and close up after he’s already left the pool, ocean, or lake,” the medical website reports. “That shuts off his airways, making it hard to breathe.”

It sounds like every parent’s worst nightmare. But in addition to being a truly frightening thought, “dry drowning” is also a confusing and controversial term. And there’s conflicting information about it all over the Web.

Some sites use the terms “dry drowning” and “secondary drowning” synonymously, while others maintain they are two different conditions. But experts on the issue assert that there are no specific types of drowning — rather, there’s a spectrum of drowning.

Drowning, by definition, is a process of respiratory impairment, which occurs on a continuum of severity. So “the term ‘dry drowning’ is inaccurate,” says Dr. Andrew Schmidt, who took the time to speak with Babble about this timely issue. Dr. Schmidt is the coauthor of a recent and influential article in the medical field called “Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning.” He’s also an assistant professor with the University of Florida-Jacksonville Department of Emergency Medicine, a medical director for Jacksonville Beach Ocean Rescue, and the director of Lifeguards Without Borders.

Dr. Schmidt explains that when a fatal drowning occurs on land, the death is always preceded by symptoms, which worsen with time. He adds that death by drowning does not occur suddenly without any symptoms, unless there are other factors at play, such as injury or illness.

Dr. Mike Patrick, an emergency medicine physician and the host of PediaCast at Nationwide Children’s Hospital, also weighed in on the topic, telling Babble that “dry drowning” isn’t considered to be an accurate medical term. “Drowning is drowning, and it can be fatal or non-fatal,” states Dr. Patrick — confirming a stance that’s backed by the CDC, World Health Organization, American Red Cross, and other organizations.

But how does drowning occur once out of the water? After all, when most of us think about drowning, we picture someone thrashing around in a pool and gasping for air — not someone talking and walking around.

“By definition, drowning is when someone’s airways drop below the surface of the water and they experience breathing problems from that,” says Dr. Schmidt. “Everyone gets wrapped up in the amount of water, but that is missing the point. A little bit, a lot, fresh, salt, warm, cold, it doesn’t matter. Yes, [inhaling] water can set off an inflammatory response … [But] people don’t die because they inhaled water, they die because while they were under water and due to inhalation, their airways are blocked and they cannot receive oxygen.”

According to Dr. Schmidt, nonfatal drowning cases causing mild to moderate symptoms are far more common than fatal drowning cases. And it’s rare for mildly symptomatic cases to result in death. But because “all drowning (non-fatal and fatal) is most common in children, with 0-4 age group making up the highest risk group,” it’s important for parents to know the signs of drowning.

“The primary symptoms to look for,” Dr. Schmidt tells Babble, “are trouble breathing, coughing, foam/fluid coming from the mouth, altered mental status, continued nausea/vomiting. It is very common for kids to jump in and come up coughing, but this subsides quickly without continued symptoms. When these symptoms continue it should be concerning, especially after a more prolonged submersion time.”

Dr. Patrick advises parents to watch their kids closely for the first 24 hours or so after a submersion, and to seek medical attention at the onset of respiratory issues.

“Call your doctor or take your child to an emergency department,” he says. “Pediatric-specific facilities are best if available. If your child develops severe difficulty breathing, call 911.”

Treatment of drowning also varies depending on severity, explains Dr. Patrick. “Mild symptoms may simply require a period of observation in the emergency department or hospital room,” he notes. “Severe symptoms require supportive care, such as oxygen, mechanical ventilation and the possibility of life-supporting medications in an intensive care setting.”

While stories about youth drownings may deter some parents from allowing their kids to ride the waves this summer, Dr. Schmidt says that parents should not be afraid of exposing their children to water. In fact, intentional exposure may help keep them safer. (“Children need to be confident in and around the water and every skill helps,” he says.) But most importantly, Dr. Schmidt stresses that parents need to take basic safety measures like making sure there’s fencing around the pool and keeping non-swimmers within arm’s reach.

Drowning is a real and scary possibility, but the fear of it happening to our kids doesn’t have to be consuming.
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Dr. Patrick explains that swimming lessons reduce the risk of drowning in children over a year old, but “they do not make your child drown-proof.” He adds that “constant adult supervision is still required for kids of all ages.”

Dr. Patrick recommends that parents take a water safety and CPR class to be prepared in an emergency. He also encourages parents, when taking their kids swimming, to “designate an adult in your party to keep constant supervision of your children, even when there is a lifeguard present. The designated adult should not be engaged in distracting conversation and should not be reading a book or on their phone … Drowning happens quickly and is usually silent.”

Drowning is a real and scary possibility, but the fear of it happening to our kids doesn’t have to be consuming. There are many steps we can take as parents to reduce the risks, and staying informed with current and accurate information is chief among them. It not only helps us make safer choices for our kids, but can keep our sanity intact with reality checks.

As Dr. Schmidt reminds us:

“It is very common for children (and adults) to submerge under water and come up coughing sometimes, just like if you drink something and it goes down the ‘wrong pipe.’ People always like to use that as an example of, ‘Well does that mean you are drowning when you choke on your drink?’ No, common sense will tell you that is not drowning, just as when some one jumps in or falls under water for a second and comes up coughing, that is not necessarily drowning.”

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