Secondary drowning explained

As kids spend time in the water, officials warn parents to keep a close watch to ensure children don't drown. But there is another condition parents should know about: secondary drowning. It afflicts children who survive a near-drowning incident. And though it's uncommon, it can be fatal if left untreated, according to Dr. Melissa Sparrow, clinical director for pediatric inpatient and emergency services at Greater Baltimore Medical Center.

What is secondary, or dry, drowning?

Secondary drowning is a term that is used by the public, and less so by physicians. It means drowning from secondary symptoms that have occurred as a result of an earlier submersion incident. That is, someone develops late onset respiratory symptoms after a period of well-appearance after a near-drowning incident. In medicine we use the terms drowning, or near-drowning. If you survive a drowning incident, then it was really a "near-drowning." If you have an incident and then seem fine and then later die, this could be called secondary drowning, because the asphyxiation process occurs in the context of later (secondary) not primary (immediate) symptoms. The fluid in the lungs is not fluid that has been breathed in, but fluid that has filled up the lung alveoli as part of an inflammatory response. Death from this is very rare. Death from this is also not "dry." The lungs do fill with fluid.

How common is it in children and can it also happen to adults?

The more I read about secondary drowning, after near-drowning incidents, the more the statistics seem unreliable. I believe it is rare. In my many years as a physician, I have only seen one case. What is measured by regulatory bodies and institutions like the Centers for Disease Control and Prevention are actual immediate, unintentional cases of drowning. These are good statistics that we have and can break down by age group, location etc. Secondary drowning stories gain a lot of media attention because they inspire panic in well-meaning parents.

What are the symptoms and how are they different from a near-drowning incident?

Secondary drowning can be difficult to recognize since initially the victim appears to be OK right after the near-drowning incident. Children who have experienced a near-drowning incident — not just swallowing water or coughing — may appear well in the initial hours, then become more fatigued than normal, have poor color, develop a cough. Keeping an eye on how quickly the child is breathing, how the neck, chest, abdominal muscles are being used, are most important. Also, it's important to monitor the child's cognition. Sleepy is one thing, but not thinking straight is another. Any changes in ability to think or speak need to be evaluated. If these kids get medical care, they usually do fine.

What should caregivers do if there are symptoms, or if there are no symptoms but there's been a near-drowning incident?

The child should be watched closely for the next 24 hours. If caregivers have any concern, they should call the child's pediatrician. If there is no pediatrician or the child is becoming more sleepy, having difficulty breathing or the child's condition seems to, in general, be worsening, the child should be brought to an emergency department.

Should small children be discouraged from going underwater, or are there other preventive measures?

Children 4 years of age or older need to learn how to swim. Also, children need to be watched at all times when swimming. Flotation toys do not guarantee any kind of safety. Again, any child who has had a near-drowning incident should be watched closely for 24 hours by caregivers.

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