"Secondary Drowning” in Children: An Important Message for All Parents
Wellness
Understanding secondary drowning in children: a silent danger after water play
Recently, concerns around secondary drowning have gained significant attention, especially after a mother shared her alarming experience on the popular blog "Delighted Momma." Her nearly 2-year-old son developed serious respiratory issues following a brief submersion in a spa. After playing in the spa and being under water the child he seemed “totally fine after he had calmed down,” she decided to take him home rather than seeking medical care.
Within an hour or so, her son seemed overly tired and began coughing, so she immediately took him to the closest emergency center. A chest x-ray showed that he had likely aspirated some of the water, which caused his lungs to not function normally. Fortunately, he was discharged after a 24-hour observation at a pediatric children’s hospital, but the parental/public interest in “secondary drowning” after her blog went viral remains a significant topic of discussion! If she hadn’t seen the secondary drowning symptoms and waited to bring her kid to the hospital, there could have been worse consequences. This incident has heightened public awareness about secondary drowning, a rare but potentially life-threatening condition where water inhaled during swimming can cause breathing difficulties hours later. Secondary drowning poses a serious risk to children, and it's crucial for parents to stay vigilant and monitor their kids closely while swimming and after.
What is “secondary drowning”?
Secondary drowning, also known as "delayed drowning" or "dry drowning," occurs when a small amount of water is inhaled into the lungs during a near-drowning or submersion incident. Unlike traditional drowning, where someone cannot breathe underwater, secondary drowning can happen hours after the person has left the water.
When water enters the lungs, even in small quantities, it can cause irritation and inflammation, leading to fluid buildup (pulmonary edema). This reduces the lungs' ability to oxygenate blood, potentially leading to breathing problems or even respiratory failure. Symptoms of secondary drowning can develop within 1 to 24 hours after the incident.
Although, secondary drowning may be a known term, it’s actually a misnomer. There is no medical condition known as ‘secondary drowning’. The correct medical terminology that is used for water submersion events that is no fatal is ‘submersion injury’.
“Secondary drowning” is a confusing misnomer that has been used to describe delayed-onset breathing problems in a child who seems to be recovering after a submersion event. When referring to “secondary drowning,” most people are referring to the complications that occur as a result of aspiration of water into the lungs. When a child aspirates any foreign substances, including fresh/salt/chlorinated water or vomit, it can cause progressive injury and inflammation within the lungs. As the lungs become more ineffective and fluid accumulates within the lungs, symptoms such as coughing, fast breathing, increased work of breathing, low oxygen levels, and altered mental status (irritability or lethargy) may quickly occur. Luckily, most healthy children who appear well after a submersion aspirate only small amounts of water, if any, and will recover spontaneously.
Secondary drowning symptoms and signs
The signs and symptoms of secondary drowning can show up right after swimming or hours later. Parents can become familiar with common signs and symptoms of secondary drowning in a child and know when to seek medical help.
Secondary drowning symptoms in a child after a water-related incident:
- Persistent coughing: If your child continues to cough after being in water, especially if it’s frequent or severe, it may indicate water in the lungs.
- Trouble breathing: Look for signs of labored breathing, such as rapid breaths, shallow breaths, or visible chest retractions.
- Fatigue: Unusual tiredness or lethargy may be a sign that the body is not getting enough oxygen due to lung impairment.
- Chest pain: Complaints of pain or discomfort in the chest can be a warning sign of fluid buildup in the lungs.
- Vomiting: This can occur due to the body’s response to low oxygen levels.
Behavioral changes: Confusion, irritability, or sudden changes in mood may indicate a lack of oxygen reaching the brain. - Pale or blue skin (cyanosis): This is a sign of oxygen deprivation and requires immediate medical attention.
If you notice any of these symptoms after your child has been swimming or submerged in water, seek emergency medical care right away to prevent severe complications.
Delayed drowning
Delayed drowning, often referred to as secondary drowning, occurs when a person inhales water into their lungs, causing a delayed reaction in the body. Unlike traditional drowning, where the lack of oxygen happens immediately, delayed drowning can occur hours after the person has left the water. Delayed drowning symptoms are similar as secondary drowning symptoms. This happens because the inhaled water causes irritation and inflammation in the lungs, which may lead to a buildup of fluid (pulmonary edema) and reduce the lungs’ ability to oxygenate blood effectively.
Secondary drowning and delayed drowning are terms that are often used interchangeably, but they describe slightly different mechanisms related to water inhalation after a submersion incident. Both can lead to symptoms in children even hours after being in water. Secondary drowning specifically refers to water in the lungs leading to breathing complications, while delayed drowning can describe any delayed respiratory distress caused by water exposure, whether or not the lungs are directly involved.
Secondary drowning when to worry
Secondary drowning occurs when a child inhales water, leading to complications that can develop hours or even days later. Know what to do when your child or toddler went under water for a few seconds or inhaled water. It’s crucial to recognize the secondary drowning signs and symptoms and know when to worry. Symptoms may include persistent coughing, difficulty breathing, chest pain, extreme fatigue, or changes in behavior. If your child experiences any of these symptoms after a near-drowning incident or even after playing in water, seek medical attention immediately.
Remember, timely intervention can be vital with secondary drowning signs in a child, so don’t hesitate to consult a healthcare professional if you have concerns about secondary drowning. What may look like a simple cough or cold after swimming, maybe something much more and require medical attention. If you notice your child or toddler coughing a lot or at night after swimming, don’t dismiss the symptoms and take them to a doctor.
What to do if your child is found underwater: a guide to drowning and secondary drowning response
Drowning can happen in seconds, and knowing how to react immediately could save your child’s life. Whether your child is conscious or unconscious after being found underwater, it’s essential to take swift and appropriate action.
Secondary Drowning - If your child is unconscious or not breathing:
- Administer Rescue Breaths: Start by giving 5 rescue breaths if your child is not breathing.
- Perform CPR: If there’s no pulse, begin CPR right away. Make sure a bystander calls 911 while you administer chest compressions and continue rescue breathing until help arrives.
- Prevent Aspiration: If your child vomits, gently roll them onto their side to prevent choking or aspiration.
- Neck and Head Support: If trauma is suspected (e.g., from diving into shallow water), keep your child's neck immobilized in a straight, midline position to avoid further injury.
Secondary Drowning - if your child is awake and alert:
Even if your child appears fine after a submersion incident, it’s crucial to remain vigilant. Keep your child warm and dry, and contact your pediatrician for further instructions. This is particularly important because the symptoms of secondary drowning (or delayed drowning) can develop hours after the incident.
Because most symptoms of non-fatal drowning occur within 6-8 hours from the submersion, it would be important to keep a close eye on your child and watch for breathing difficulties, skin color changes, persistent vomiting, or abnormal behavior. If any of these symptoms occur, you should seek medical care immediately.
What to expect after a water submersion incident: emergency room care for secondary drowning
If your child is taken to the emergency room with secondary drowning symptoms or delayed drowning symptoms, here is what to expect.
- Initial Assessment: Upon arrival, your child will undergo a quick assessment of vital signs, including breathing rate, oxygen levels, heart rate, and blood pressure. The ER team will check for signs of respiratory distress or cyanosis (bluish skin), which indicates low oxygen levels.
- Oxygen Therapy: If your child has difficulty breathing or low oxygen levels, supplemental oxygen may be provided to help stabilize them.
- Chest X-ray: A chest x-ray is often performed to check for fluid in the lungs (pulmonary edema) or signs of water inhalation, which are common in secondary drowning.
- Blood Tests: Blood tests may be ordered to assess oxygen and carbon dioxide levels in the blood, ensuring that the lungs are functioning properly.
- Observation Period: If secondary drowning is suspected, your child may be monitored for an extended period, typically 4-24 hours, to ensure that symptoms do not worsen. This is crucial since symptoms can develop or escalate over time.
- Treatment for Complications: If fluid buildup in the lungs is severe, your child might require more intensive treatments, such as mechanical ventilation or medications to reduce inflammation and fluid retention in the lungs.
- Discharge Instructions: If your child stabilizes, the ER team will provide discharge instructions, which may include monitoring for any delayed symptoms at home and follow-up appointments with a pediatrician.
Based on the details of the submersion, secondary drowning symptoms and your child’s vital signs, the physician will likely order a chest x-ray and possibly blood tests to evaluate lung function and oxygen levels. If the exam, x-ray, and lab results are normal, your child may be observed in the emergency department for around 6 hours to monitor for delayed symptoms. As long as your child remains stable during this observation period, they will likely be discharged home with detailed instructions for monitoring and when to return for further care.
However, if your child’s examination and/or workup are abnormal, he/she will be admitted for supportive care to treat the secondary drowning symptoms (i.e., oxygen, breathing treatments, intravenous fluids, etc.) and observation. Children who are very sick with decreased/lack of responsiveness, severe breathing difficulties, or very low oxygen levels are typically admitted to a pediatric intensive care unit (PICU) for increased respiratory support/treatment and close monitoring.
Childhood drowning and secondary drowning is quick and quiet!
Drowning is the second-leading cause of unintentional injury-related death for children ages 1 to 14 years, with the highest rate of drowning in the 0- to 4-year-old age group.
To prevent children from drowning or having secondary drowning symptoms, take proactive measures to ensure the safety of your children around water. Some ways you can protect children are to enclose and cover pools and hot tubs, childproof your home by closing bathroom doors, using safety locks on toilet seats, draining bathtubs, and emptying buckets and ice chests filled with water. Also, enroll your children in water safety and swim classes, continuously (touch)-supervise or designate a responsible adult to watch over your children, have adult supervision when swimming and learn first aid and CPR. Learn more about water safety with children and drowning prevention.
The “Delighted Momma” blog has not only brought “secondary drowning” into the spotlight, but also the fact that childhood drownings and delayed drowning happen unexpectedly, quickly, and quietly! Lindsay Kujawa was sitting near her child and for “less than five seconds”, turned to speak with a family member, while her child silently slipped under water. Unfortunately, this type of scenario is common, and I cannot tell you the number of times that parents have similarly told me they turned away from their child for “just a second”…to look for another child, converse with a friend, or make a quick meal….prior to finding their child in a pool, bathtub, or bucket/ice chest. Watching your child in the water and knowing the symptoms of secondary drowning can help keep your toddler or kid safe. Learn more about drowning prevention tips.
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