M. Denise Dowd
Representation of drowning symptoms and epidemiological factors on social media and news outlets may cause additional parental concern about “dry drowning,” or a drowning event that hypothetically occurs hours to days after a child inhales water.
“Unfortunately, terms like ‘dry drowning’ have been used in several frightening stories in mainstream and social media,” M. Denise Dowd, MD, MPH, associate director at the Office for Faculty Development and the medical director of community programs in the department of social work at Children’s Mercy Hospital, wrote. “Parents reading these reports are led to believe that there are no warning signs and that critical distress or death comes out of nowhere.”
To assess the myths surrounding pediatric drownings, Dowd analyzed the differences between drowning and “dry drowning,” as well as the epidemiology of the phenomenon, treatments and prevention methods.
The term dry drowning was coined in the 1930s and 1940s through animal studies in which insignificant amounts of water in the lungs were observed postmortem. This phenomenon was attributed to prolonged reflex laryngospasm causing lethal hypoxia due to postobstructive pulmonary edema. Most studies regarding dry drowning have been rejected because no solid evidence has supported the hypothesis.
Dowd noted that in 2002, a standard definition of drowning was adopted by the World Congress on Drowning: “a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.” According to the organization, death, lasting impairment or complete recovery are possible, but all drowning events should be investigated as such, with designations only for fatal and nonfatal drowning.
By this definition, 10 people die of drowning daily in the United States. Of these people, one in five are aged younger than 15 years. Additionally, five children receive emergency treatment for nonfatal drownings for every pediatric drowning death.
Rates of drowning have significantly decreased over the last 30 years. This statistic can be easily observed in 19-year-olds, who accounted for 1,886 deaths in 1985 and 892 in 2014. Those at greatest risk of drowning are children aged between 1 and 4 years, especially in swimming pools. Teenagers are also at increased risk of drowning, and these events mostly occur in lakes or rivers.
According to Dowd, less than 6% of those who are assisted by lifeguards need ED treatment for drowning; however, it is important that health care providers be aware of the symptoms of drowning, which appear quickly and include persistent to worsening cough, tachypnea, vomiting and mental status changes. Few drowning events have resulted in symptom development after 4 to 6 hours.
For the assessment of drowning, children should be accompanied to the closest ED, and oxygen levels should be observed. Once the child has normal oxygenation, has done well for 6 to 8 hours and is symptom-free, Dowd suggests that they may be discharged home with appropriate follow-up care. Unneeded testing and treatment steps include checking electrolytes, collecting complete blood counts and the use of prophylactic antibiotics.
Other myths about drowning were assessed by Dowd, including parental beliefs that children are safe once they know how to swim and that drowning is easily identifiable in the moment. Although these are not always true, the AAP has suggested that drowning is a preventable event that can be prevented by adequate supervision in combination with pool fencing and other barriers. The organization also recommends proper training of children and parental readiness to respond to emergency situations.
“Fortunately, children who have trouble hours after submersion event have warning signs that can be detected by an experienced provider,” Dowd wrote. “Having a firm knowledge of how drowning occurs is essential in clinical care of patients as well as in discussion with parents.” – by Katherine Bortz
Disclosures: The author reports no relevant financial disclosures.