Katherine H. Hensley, MD, FAAP, is a pediatrician at The Children’s Clinic in Corpus Christi, Texas. This article first appeared on her blog at dockatevaccineblog.wordpress.com.
Let’s talk about dry drowning. I’ve been encountering a lot of misunderstanding about dry drowning (which, by the way, is not an accepted medical term; drowning is drowning, with or without mortality). Delayed mortality from drowning has hallmark symptoms and parents need to know what those look like as well (and also when not to worry). In short, your child is not going to go swimming, swallow some water, have no issues in the water whatsoever, and then suddenly die without warning four days later from “dry drowning”. I know the stories you’ve been reading – they’re all over my newsfeed, too. I know how the thought of losing your child makes you have actual physical chest pain because it does that to me, too. I don’t have a pool at my house and that is intentional. I don’t want to take the risk that my kid could end up in it unsupervised. But I don’t want the kids of the world never going near the water again because their parents were frightened by a poorly researched Facebook article.
Remember that there is a lot of fake news and misinformation on the internet. Many authors do not care about delivering accurate, useful information. They care about the sensational headline.
My major issues with the stories I’ve been reading lately are these: first, their misuse of the word “swallowing” when they mean aspiration. Second, their lack of discussion about real symptoms of actual drowning that parents should be watching for. Far too many kids die from drowning every year and it would be wonderful if the press would talk to some medical experts and get better information about drowning prevention out there to parents. Most of the stories I’ve read, however, give parents the impression that kids who have drowning with morbidity (the accepted medical term, check out the links below) swallowed some water, were fine for a few days, and then suddenly died. It doesn’t really work like that. Drowning is more dramatic.
Here’s the deal, in brief: a human may experience inflammation in the lungs (pneumonitis) with massive fluid production and death after aspirating water. This is not the same thing as swallowing water and many people don’t understand the difference. Swallowed water goes into the esophagus and down through the digestive tract. Swallowing chlorinated pool water may make you throw up but it will not make you die of flash pulmonary edema. Aspiration is when the water goes into the trachea and down into the lungs. In this case, the patient in question will have an episode of distress after they come out (or are pulled out) of the water. You will see it and you will know they are not okay. They will take longer to recover than they would after choking on a little orange juice at the dinner table. They will cough and gasp and sputter. They may even require intervention like CPR. And I’m pretty sure everyone understands that a child who is down in the water, gets pulled out, and requires resuscitation needs immediate medical attention, even if they seem to recover. If your child has an episode like this and then later continues to have coughing, vomiting, wheezing, chest or belly pain, or seems abnormally tired, we have a problem. Get to the ER. If your child goes swimming and does not have an aspiration event and afterwards they are perfectly fine … they are perfectly fine. Go ahead and go to the beach this weekend, people.
The key to preventing drowning? Supervision. There needs to be a designated child watcher. Just because there are 10 adults present doesn’t mean one of them is paying attention to the kids. Have a plan. If it’s a party where you don’t really know anyone, this is not the time to make new friends. Watch your kids. If you’re watching them and they have an aspiration event, you will see it and you will get them the medical attention they need. If your child is participating in swimming activities when they are not with you, be the annoying parent. Ask questions about who will be supervising. Ask if anyone present has had lifeguard training. If you don’t like the answers you get, don’t send your kid. Hosting a pool party yourself this summer? Consider hiring a lifeguard.
Oh, and wear sunscreen.
Drowning is the number one cause of death in Florida for children ages 1-4, and this is a statistic we can all help to change. Here are 10 tips for keeping your family safe in and around water from Leigh Ann Newman, Neapolitan Family co-publisher.
1. Adult supervision. And I don’t mean sitting by the pool with a book or your phone (although you should keep your phone handy in case of an emergency). Drownings are silent. You won’t hear a scream or a splash. A child can lose consciousness after being submerged for two minutes. After 4-6 minutes, permanent brain damage can occur.
2. Swimming lessons. Children can learn to float as young as six months old, and kids at any age need to know how to keep themselves safe in the water. There are a variety of pro-grams and instructors out there. Ask your pediatrician and friends for recommendations.
3. Throw out the water wings. Water wings are toys – dangerous toys. If you are using a flotation device, make sure it is U.S. Coast Guard approved. However, never depend on flotation devices to take the place of adult supervision. Young children can, and do, take off puddle jumpers and life jackets.
4. Physical barriers. A must for any backyard pool is a fence at least four feet high, with a self-latching and self-locking gate. Pool fences save lives. Period. But they are not fool-proof. Even self-latching gates don’t always close. Older siblings and even adults can forget to latch the pool fence, so check the fence and the gate regularly.
5. Check the furniture on the lanai. Children have climbed over pool fences and drowned. If a table or chair is light enough for a toddler to pick up or push, don’t leave it on the lanai.
6. Hire a lifeguard for parties. For $100-$200, you keep everyone safe and lessen your own stress. If that’s out of your price range, designate an adult (who can swim AND has not been drinking) as the pool watcher. Switch every 30 minutes.
7. Learn CPR and first aid. Be prepared in case of an accident; minutes matter.
8. Take the toys out of the pool. Many babies and toddlers fall into pools while reaching for a toy. Remove the temptation when you are done swimming for the day, and you’ll have the added benefit of your pool filter and chemicals working more efficiently.
9. Talk to your kids. Start early. Go over the pool rules every day your kids are in the water. Your words will sink in and can prevent accidents.
10. Get in the water with your kids! Once you get over getting your hair wet, you’ll discover what a blast you can have with your kids in the water, especially while they are young enough to still want Mom and Dad in the pool.