Mom and child in pool

Secondary Drowning: Know the Signs

Back in 1999, we had a pool party for our daughter’s fifth birthday. And since there would be lots of little ones swimming in the shallow end of our backyard pool, we decided to hire a lifeguard to ensure a trained set of eyes were always on the water. Our daughter and a couple of her friends were already in the pool when the lifeguard arrived. It was then (before the hired help had the opportunity to step out of his street clothes) that our usually hesitant two-year-old son decided to jump in and join the girls.

He went straight to the bottom.

Fortunately, the lifeguard sprang into action (street clothes and all), rescuing our son and validating our decision to hire him. Aside from brief coughing and sputtering, our son was no worse for the wear.

As it turns out, the overwhelming majority (95%) of kids with a close call in the water do fine, but a few (5%) don’t. Those few may go on to develop “dry drowning” or “secondary drowning.” Knowing the signs and symptoms of these conditions—and what to do if problems occur—can mean the difference between life and death for kids who initially appear well after a brief struggle in the water.

Dry Drowning
Dry drowning occurs when water irritates the upper airway, causing the vocal cords to spasm (laryngospasm) and restricting flow of air into the lungs. This triggers a shock reflex called neurogenic pulmonary edema. The lungs begin to fill with body fluid (not pool water), which interferes with oxygen and carbon dioxide exchange. Oxygen is depleted, carbon dioxide builds up, the shock reflex strengthens, and a deadly spiral ensues. The symptoms of dry drowning usually begin within an hour of water exposure.

Secondary Drowning
Secondary drowning takes a little longer to set in (1 to 24 hours). In this case, a small amount of pool water enters the lungs, disrupting a substance (surfactant) that coats the inside surface of the tiny airways deep inside the lungs. This substance prevents the airways from collapsing and sticking together. With the surfactant disrupted, the small airways collapse and air flow is restricted. To make matters worse, body fluid is sent into the lungs (pulmonary edema) in an effort to open the airways. Unfortunately, this interferes with gas exchange, and the deadly cycle we see with dry drowning rears its head.

Symptoms To Watch For
You’ll want to keep a close eye on your child during the 24 hours following a close call in the water. Symptoms of dry drowning and secondary drowning are the same and include shortness of breath, difficulty breathing, coughing and/or chest discomfort. Fatigue, irritability and behavioral changes are also common.

What To Do
Remain vigilant for 24 hours after a close call in the water, even if your child appears happy and playful with no symptoms at all. If your child begins to exhibit any respiratory symptoms or unusual behavioral, seek medical help right away. Don’t wait! Call 911 if you have to. There is no specific treatment for dry drowning or secondary drowning, but supportive care in a pediatric facility is your child’s best chance for survival.

On the other hand, there’s no reason to panic if your child does not display symptoms. Remember, these are rare events and there’s no way to diagnose them or predict who will be affected before symptoms set in. Simply remain watchful and ready to act.

Prevention Is Important Too!
Our two-year old should not have been able to dart into the pool, even with a lifeguard present. We were guilty of inadequate supervision, and the results could have been deadly. Be sure to read our tips for Keeping Your Kids Safe in the Pool before heading out to play in the water this weekend.

Mike Patrick, MD
Dr. Mike is an emergency medicine physician at Nationwide Children’s and host of PediaCast, our pediatric podcast for moms and dads. Each week, PediaCast covers news parents can use, answers listener questions, and delivers interviews with pediatric experts on a variety of topics. Dr Mike is also an Assistant Professor of Pediatrics at The Ohio State University College of Medicine, where he serves as a faculty advisor for medical students. On the home front, he is married with two kids: a college-aged daughter and a son in high school. Prior to working in the emergency department, Dr Mike spent 10 years in a busy private practice, a time he says most prepared him for the practical advice he shares on PediaCast. Dr Mike also has an interest in roller skating. He learned to walk with skates on his feet, and his first job (age 10) was as a disc jockey at his hometown roller skating rink. He has also worked as a DJ at two radio stations, experiences which further prepared him to host our podcast!

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