A Reality Check on Dry Drowning

*As promised, I’ve come back to edit and flesh out a bit.  Enjoy!

Dry Drowning Is Not A Thing

OK, it’s a thing and a very bad thing but I’ve been encountering a lot of misunderstanding about what it is (and what it isn’t).  Drowning claims the lives of WAY too many children every year and real prevention comes down to supervision when kids are in the water.  Delayed mortality from drowning has hallmark symptoms and parents need to know what those look like as well (and also when not to worry).  OK, let’s talk about dry drowning (which, by the way, is not an accepted medical term – drowning is drowning, with or without mortality, see links below for more details).

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 4 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 OK.  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 ED.  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 ten 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.

OK, good talk!  Oh, and wear sunscreen.

Lucky for me, the emergency medicine docs of the world have already knocked this topic out of the park so go read their stuff.  You’ll feel better.

http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?PostID=377

http://www.drowninglit.com/2017/06/on-dry-drowning.html

https://docs.google.com/file/d/0B3Ylak5R8rxwU2FyMWVtSGNTVGc/edit

http://www.who.int/bulletin/volumes/83/11/vanbeeck1105abstract/en/

http://newsroom.acep.org/2017-07-11-Death-After-Swimming-Is-Extremely-Rare-And-Is-NOT-Dry-Drowning

 

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52 thoughts on “A Reality Check on Dry Drowning

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  1. Very misleading article. There absolutely IS such a thing as dry drowning and you may have caused parents to relax while their little ones are around water. They need to keep their face out of their phones and WATCH their precious babies.

    Liked by 2 people

    1. I’m sorry you feel that way. It’s not at all my intention to make parents complacent. On the contrary I am trying to stress the importance supervision around water. “Dry drowning” is not an accepted medical term and it is confusing to parents. Drowning with morbidity is real but it has hallmark symptoms. I have had moms in my office who are wanting to keep their kids out of water for the rest of their lives because of these stories when in reality, swimming lessons at an appropriate age would increase their safety. Water is to be respected but not feared and avoided. You are absolutely right the supervision is the key to preventing drowning deaths.

      Liked by 9 people

    2. That’s exactly what I just posted when I shared this to facebook. This article describes dry drowning while saying its not a thing? I don’t know anyone who thinks it means a child swallows water vs aspirates it. All the symptoms in this article are exactly the same symptoms from every “click bait” article.

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    3. I think that is what she said: WATCH your kids! Hire a lifeguard! Be the annoying parent! Nothing about this post makes me want to relax about my kids and swimming. The author is only clarifying medical conditions and terms. And if anything, she is reiterating how important it is that parents or adults in general supervise their kids while swimming.

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    4. I don’t usually negative comment. But I also have to agree. My Child gasped on some water the other day. I went over and gave her a hug to calm her down and she was playing a minute or so later. Later that day she got an all of a sudden chest cold and was tired from playing all day. now, luckily this was very poor timing, and it was in fact a quick come on cold. shes 9, and I didn’t think the chances were likely that it was more than that. But I called the nurse line just to be safe. They did in fact think dry drowning was a thing and had us get her vitals checked. it took maybe 10 minutes of our time in the pediatric ER. it was worth it! Keeping kids from water isn’t a good idea either, because they will find water one day. Your child is going to bump his head, it doesn’t doesn’t mean its a concussion or to wrap him in bubble wrap so that it never happens again. It also doesn’t mean that you shouldn’t watch out for signs of a concussion!. Its rare, its really rare. but somebody’s kid has died from this thinking it was nothing. Often the symptoms subside, but not always. I know your intent wasn’t to forget about the poor parents who suffer everyday from a loss that is just completely unimaginable without experiencing it first hand. I do, however, think some of those parents might disagree with how you went about this. I believe your intent was to say “have faith, have fun with your kids. There are scary things out there, we cant save them from everything. but having a habilitating fear will limit you and your kids from enjoying all life has to offer”. That I agree with!

      Liked by 2 people

      1. How can you post that education is important while saying the “semantics of medically accepted or not are not important?” Education–including actual terms for conditions–is important.

        Like

  2. Thank you so much for posting this. I’m so tired of every summer seeing all the dry and delayed drowning scare posts and tweets. It literally terrified me the first time I read about it. The last article I read about a kid dying at wolf lodge actually made me mad. It mixed up terminology, didn’t give enough information on anything, and was basically the blame game. Y’all, watch your kids. I’m at the pool nearly every day teaching my kids how to swim, and there are so many unattended, rowdy, obnoxious kids running around doing stupid things.

    Liked by 2 people

  3. Thank you for this article. I watched my 3yr old granddaughter “drink” pool water several times, coughing each time (even to the point of vomiting once) which kept bringing the dry drowning thoughts to mind. I wish I had read your article beforehand!! As you stated, she is perfectly fine!

    sheri

    Liked by 2 people

  4. I agree with Audley. Dry drowning and secondary drowning are absolutely real and your article is misleading. Ask someone who has lost a child to “dry drowning” and this article is a slap in their face. I really appreciate your effort to help parents feel “less worried” about this rare type of drowning but please don’t sacrifice truth in your attempts to help us relax. Let’s don’t get caught up on terminology. Just because the specific term “dry drowning” is not an “accepted” medical term does not make it unreal. Most of us could care less whether the term is considered “accepted.” As a side note, the term “drowning with morbidity” is absolutely too confusing for most to understand. Keep it simple, yet truthful….. Let people know that dry drowning (however you want to call it) is real, educate them on the symptoms/warning signs then make them aware that there’s only a 1-2% chance that it will actually happen to them or someone they love.

    Liked by 1 person

    1. They have only recently discontinued the use of “dry drowning, secondary drowning, etc” so that they could all be on the same page. But that doesn’t help when people don’t understand that drowning isn’t just done all at once. In cases where a child dies from dry drowning it wouldn’t even be considered drowning with morbidity, it would be fatal drowning which most people would assume meant they drown in the “normal” way. I agree with you 100%. Articles like this give a false case of security…dry downing is definitely a thing and parents need to be made aware, no matter what you want to call it.

      Like

    2. Actually, these incidents only make up about 1-2% of all drowning incidents. Saying that there’s a “1-2% chance of this actually happening to them or someone they love is” is especially misleading. It’s like saying that 1 or 2 of 100 people you know will ahve this happen to them and that’s just plain wrong.

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    3. Amanda, do you understand what a 1-2% chance means? It means that 1-2 people in 100 will die this way. That would make it approximately 100x more common than suicide. Overall drowning deaths occur in about 1 in 1100 people, and *of these,* 1-2% are related to “dry drowning.” That’s 1 in 110000, or a .00001% chance; your estimate is literally off by over one hundred thousand.

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  5. This is exactly what I’ve always heard described as dry drowning: it’s the lay man’s terminology for what you’re citing as drowning with morbidity. I’ll second that this article is misleading. While the few will believe swimming is to be avoided at all costs, the majority of people who have heard of dry drowning know it to be exactly as described in your article. And ironically enough, I saw your article title “Dry Drowning Doesn’t Exist” on Facebook. Now imagine the many other people who read the title, accept as truth that children can’t actually die from aspirating while swimming, and move on with that incorrect information. Because as parents, we’d much rather blindly believe that our kids can’t fall prey to something scary and accept this at face value than be well informed.

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  6. intrestion artical, however i feel it is missleading. not all kids show signs of aspiration. My daughter has what is called silent aspiration (dr diagonsed), there are times she aspirates and you have no idea until a few days later when she is sick.

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  7. She’s not saying that dry drowning doesn’t exist. In fact, she is very clear that (in its proper terminology) DOES exist. He is simply explaining why every parent shouldn’t assume a child is suffering from “dry drowning” just because they swallow water. I appreciate this article, because now I know the REAL symptoms to look out for, rather than the hysteria that the other articles are creating.

    Like

  8. Thank you so much for this article. It makes sense to me now. My children are grown but I have 5 beautiful grandsons. Every time their parents take them to do anything with water I am sick to my stomach with worry. Thank you for clearing things up!

    Like

  9. Did those of you who are complaining read the links posted at the bottom of the blog entry? The child who died most recently of “dry drowning” vomited for days. The child I first read about two years ago vomited, soiled his pants, and slept for hours in the middle of the day before he died. In each of the situations that I’ve read about, there were other signs that something was wrong. That is the point of the article; don’t worry that your child is going to suddenly die from drowning before you’re even aware that something is wrong. YOU WILL KNOW if something is wrong.

    And for all of the hysteria over “dry drowning”, there are many, many more cases of actual drowning because children were not adequately supervised. That is the much greater risk.

    This article was very reassuring to me; we have a swimming pool, and a nine-year-old daughter who is a very good swimmer but because of the sensationalist articles that my husband and I both read, we panicked every time she coughed in the water. I truly appreciated the explanation.

    Liked by 1 person

  10. What’s confusing is first assuming that semantics truly have any place in a discussion with ‘lay people’ who are not formally, medically trained when telling them the signs and symptoms to watch out for in the case of “dry drowning.” The difference between swallowing and aspiration is far less important that telling them what to look for. It’s also very uncommon for lay people to know what aspiration is. They usually just say “it went down the wrong pipe.” So would that make you happier? “If you child gets enough water ‘down the wrong’ pipe, they could have ‘dry drowning’ that us privileged medically educated people like to call pneumonitis – inflammation and irritation of the lungs for you ‘lay people’ out there *snicker*, and they could have serious complications and ever death. So watch for… But if they swallow it ‘down the right pipe’ and they end up throwing it up along with the contents of their stomach, like the hot dogs my kid blew chunks of on memorial day, well then you are gonna be ok!” I mean come on. It just seems so incredibly privileged and not at ALL helpful to take this stance against the viral post being shared on the topic. I get it- don’t add to the hype or incite fear, but certainly don’t shame them for not knowing the difference, or say it “isn’t a thing” and simultaneously, in the same breath, tell us it’s a rose by another name. You’re only confusing them more. –Signed an RN who has no issues telling my patients about the signs of “Dry Drowning”

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    1. Your comment is condescending. I’m a lay person and know what aspiration is–one doesn’t need to be one of you “privileged medically educated” people to understand that term. I found the article helpful in explaining what was really occurring and I also don’t think she was adding to the hype or playing down the need for supervision and vigilance.

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        1. I agree with Vanessa. I’m fairly sure she was referring to the way you describe yourself as “us privileged medically educated” and refer to everyone else in the world as a “lay person” who couldn’t possibly know something about this subject. I think as someone in the medical field, you may want to revise your approach as to how you “inform” people in the future.

          Like

  11. A number of people have found my originial title to be misleading or even offensive. This was never my intention so I have changed it. My intent in writing this piece is to reassure parents who have been asking me if they should literally never let their child go near a pool again. They fear that their child could have aspirated water and be at risk for mortality even with no symptoms whatsoever. I want people to have a better understanding of drowning in all its forms and still be able to enjoy the water with their children. I hope my edits make this piece less confusion. Cheers, readers!

    Liked by 1 person

  12. In like some of the people that chose to comment I get what you are saying. I just got done having this conversation with my ex wife. To those who had the negative comments that is very unkind. This post was not done to create chaos.

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  13. Thank you so much for clarifying this! I’ve been aggravated with the ‘dry-drowning’ craze and misinformation for a couple summers now. You said it very well. I did not read through all the comments to see the negative ones. You just stated facts, that most people will understand if they had high-school biology.

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  14. Using Correct terminology is NOT misleading and is very important. People without medical backgrounds believe incorrect information all the time and a physician that cares enough to help educate their patients including explaining correct medical terminology are not arrogant. Continuing to use out of date and incorrect terminology about drowning is as bad as a physician that writes antibiotic rxs for viral illnesses because patients already believe they help. If a person has a drowning event it will be obvious. A more important thing is for parents to understand what constitutes supervision. As a general rule if you wouldn’t allow your child to play in your front yard without an adult specifically watching them then they should not be in the water without an adult in the water specifically watching them. A drowning event takes only seconds to happen and is virtually silent. A focus on more vigilant supervision could help prevent drowning tragedies from occurring in the 1st place.

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  15. This is really good information and will make people a little less paranoid if they actually read the article; however, I do not like the way it has been titles. It should say something more like, “Dry Drowning is not what you have been lead to believe it is”, or something along those lines. If I kept scrolling and didn’t read the article, I would think she was just saying that dry drowning doesn’t exist and is not to be of concern or something.

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  16. Hi Dr. Kate, I thought this post was very good! You made an important point that active drowning poses a much greater risk to most children than delayed drowning, even though the latter is more sensationalized. Also, thank you for listing the signs/symptoms of aspiration. Prior to reading your article, I am not sure I would have recognized them.

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  17. I agree that there has been a panic about dry drowning that is unnecessary. Unfortunately, your article includes inaccurate information about CPR, advice that could be fatal. It is never necessary to do CPR on a person with a pulse and doing so may kill them. A child in respiratory distress may require intervention such AR (NOT CPR!) or oxygen. It is a pretty irresponsible mistake to make in this article and ironic considering that the entire article is calling out others for spreading misinformation! Please fix it.

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    1. Hi, Christi! Thanks for your comment. According to the most recent PALS guidelines for initial assessment, chest compressions should be initiated in a non-responsive child with a pulse if the heart rate is less than 60 beats per minute. This guideline might be different in adults, perhaps you have some different guidelines? I am not aware of any deaths being caused by unnecessary chest compressions, have you seen some case reports? That’s pretty scary, I’d be interested to learn more about that. Do you have some citations? https://acls-algorithms.com/wp-content/uploads/2016/06/pals-systematic-approach-algorithm.png

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  18. I didn’t say that dry drowning is common. I just said that there IS such a thing. I still feel the same way when I said your article is misleading. And to Blogging Father: my comment was not meant to be unkind or create chaos. My intent is to keep parents, grandparents, caretakers and sitters alert and aware of the possibilities.
    Go google “Oprah and dry drowning”. You’ll find a link to a show she did several years ago about a mother whose son died after being in a swimming pool for a short time. He was asymptomatic except for feeling sleepy. She put him to bed early thinking he was just tired from swimming and being in the sun.
    Why must every subject that is disagreed with be held in such contempt these days? I’m neither unkind nor trying to create chaos. Just simply trying to engage in meaningful conversation about an important subject that could either keep parents more relaxed than they should be or cause them to be neurotic and constantly worried. I’m hoping this subject and any conversations among us who are a part of it will do one thing: to keep us all alert, aware and informed.

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    1. Thank you! In the past the AAP has recommended against these sorts of classes because they can create a false sense of security for parents, the concern being that parents might not supervise their toddlers as closely if they believe they “can swim” when they in fact cannot. There have been a few, small, more recent studies suggesting these classes might indeed decrease risk of drowning but it should still be well understood that they are not a substitute for other preventive measures, such as proper fencing of pools and close supervision around water. You can read more here – https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Gives-Updated-Advice-on-Drowning-Prevention.aspx

      Liked by 1 person

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