Drowning: What parents really need to worry about
© 2014 Roy Benaroch, MD
“Summertime… and the media blows it again…”
As predictable as sunburn and mosquitoes, you can count on the usual health media nincompoops to get it wrong. But, no worries—you can count on The Pediatric Insider for reliable health info, and for our most popular series of posts, “Guilt Free Parenting.” It’s easy to find things to worry about. We’re here to tell you when you don’t need to worry.
Several news stories and posts are flying around Facebook about kids and swimming, and the dangers of “dry drowning” or “delayed drowning.” Some of these are from years past, but there are new stories that seem to be driven by a mom’s account on her blog of her child’s health scare. To her credit, the “delighted momma” correctly attributes her son Ronin’s scare to “delayed drowning,” and it isn’t until the comments on the post that people start incorrectly equating that with dry drowning. That’s then been followed by news stories from (supposedly) legit professional news organizations that continue to spread misinformation and give advice that really won’t protect children from what their parents fear.
Got that? The momma, non-professional blogger got it right. The media, predictably, blew it when they retold her story. Honestly, they should have just summarized or reposted what she said (kudos to You.Beauty, who did that and got it right, though the flow of their version of the story was oddly interrupted by links to “6 things you didn’t know about your bra” and “5 reasons your vagina itches.”)
Anyway: drowning does count as a genuine Thing to Worry About, though maybe not in the way you think you should. Despite what the media accounts say, not every child who sputters after a dunk is at grave risk. There are simple things parents can do that can dramatically decrease the risk of drowning, and simple things parents can look for to know when they need to have their child evaluated. We’ll get to those, but first let’s clear up some of the confusion that’s been created by these news stories.
Drowning, itself, means to die from suffocation after immersion in liquid. (The correct term if this happens and the person doesn’t die is a “near-drowning.”) Usually, the lungs fill with water when a person drowns—essentially, when faced with suffocation, the body will instinctively breathe in, even though there is no air. Sometimes, a spasm of the upper airway will prevent the lungs from flooding with water, causing what’s sometimes called “dry drowning.” The symptoms, though, of dry drowning or “wet drowning” will be the same—a person stops breathing and will lose consciousness and die. If the victim is pulled from the water in time, normal breathing can begin again—though there is often coughing and sputtering and sometimes vomiting and disorientation. When near-drowning occurs, whether “dry” or “wet”, symptoms are immediate. Any significant symptoms that persist or appear after any near-drowning mean that the victim needs immediate medical attention.
That’s the kicker, and really the most important lesson from Ronin’s story. The distinction between “dry” and “wet” isn’t important. What’s important is that when pulled from the water, Ronin was upset and coughing. He improved some, but remained “tired”. When he went home, he remained “more tired than usual.” Mom called their pediatrician, who sent them to the Emergency Department. There, he had a fever and was “acting limp and almost unresponsive.” Ronin needed hospital support, but ended up doing well. He would not have done well at all if he had stayed home.
Though most victims of near-drowning have continuous, obvious symptoms, Ronin experienced what’s correctly termed “delayed” or “secondary” drowning. When pulled from the water, his lungs were able to aerate just fine, so after a few minutes of coughing he could breathe. But even a small amount of pool water in the lungs can lead to problems in the hours after an incident like this. Pool or lake or ocean or tap water can lead to irritation and swelling of lung tissues, which can gradually worsen in the minutes or hours after a near-drowning. Ronin was “tired” because his body wasn’t getting enough oxygen, or perhaps because his body was working hard trying to get oxygen from injured lungs. Tiredness, or any other symptom after a near-drowning, means go to the hospital. With support, people who have delayed drowning will be OK—but they’re going to need oxygen and maybe more-intensive therapy while their lungs heal.
Other symptoms families might see during the development of secondary drowning: continued coughing, disorientation, trouble breathing or shortness of breath, difficulty talking, fatigue or listlessness, or looking pale. If your child had near-drowning (that is, had to be pulled from the water, or needed help from a lifeguard, or popped out of the water with a lot of coughing) and then develops any of these symptoms, get to the ED. Pronto.
Got that? Dunking in the water is OK, and coughing immediately afterwards isn’t necessarily anything to worry about. If there are continued symptoms after a near-drowning, go to the ED. Even if symptoms seem to improve at first, if any further symptoms evolve or persist, go to the ED. Most dunks do not require any medical attention. Look out for continued or later symptoms to know when you really need to worry.
Next up: an ounce of prevention. How to prevent drowning and near-drowning, coming later this week!