Pediatricians: Don’t get distracted by ‘dry drowning’ social media posts

By now, scores of parents have read some version of a heart-stopping story circulating around social media: A child, days or weeks after swallowing some water while swimming, suddenly dies. The doctor tells the devastated parents it’s a case of “dry drowning,” prompting them to warn others of this “rare” occurrence.

The problem: Most of those stories are more social media phenomenon than medical fact, said Dr. Ryan Redman, medical director of the emergency department at East Tennessee Children’s Hospital — and it could even distract parents from a true danger: unsupervised children drowning, something that can, and does, happen all the time.

To start with, the term “dry drowning” doesn’t mean what the stories imply, Redman said. It’s a term used during autopsy to mean someone has died from being submerged in water but has no water in the lungs.

What the warning stories seem to describe is sometimes called “secondary drowning” or “delayed drowning” by laypeople, he said: A child or adult has later complications after aspirating, or inhaling, water.

That’s certainly not unheard of, Redman said — but it would be rare for the parent not to notice at the time. A child susceptible to complications from nearly drowning would have been pulled from the water, coughing and sputtering, and in some cases would have lost consciousness or needed CPR. Symptoms would be obvious shortly afterward and progress over the next several hours — not days.

“It can be confusing for parents: Can someone go swimming, be fine, not have any real event and somehow suddenly develop symptoms and die days or weeks later?” Redman said. “That is simply something that we don’t see.”

A child who got a little liquid up his nose or swallowed a little chlorinated pool water and spit it up, then spends the rest of the day playing probably doesn’t need to be closely monitored for drowning symptoms in the days to come, Redman said.

But a child who is pulled from water after almost drowning is a different story, he said. Monitor that child closely for 24 hours — at least eight of them in the emergency department if the child lost consciousness or needed CPR, he said. Symptoms to watch for: persistent cough, labored or faster breathing, changes in mental status, an episode of vomiting shortly after the rescue. Mild symptoms can be checked out by a child’s regular doctor, if open and available, he added: “If not, that’s why we’re there in the emergency department at all hours, to make sure there’s access.”

In nearly 15 years as a pediatric emergency physician, Redman said he’s never seen a case like the ones described on Facebook. He does, however, see children come in with medical problems from almost drowning — several a week, ranging from minor cases who get checked out and go home to children who need to go to the intensive care unit. Those children aren’t “rare;” it’s estimated that for every drowning among children, there are five near drownings.

And damage to the brain, heart and lungs can begin to occur in “a minute or so,” he said. “It doesn’t take very long at all.”

That’s why Redman is hoping the interest in “dry drowning” will bring attention to those types of regular drowning events — a wholly preventable cause of death and disability. Nearly 13,000 people a year in the United States visit the emergency room for drowning; drowning results in about 3,500 deaths annually in the U.S.

In Chattanooga, Dr. Matthew Kreth, pediatric pulmonologist for the Children’s Hospital at Erlanger, said there have not been emergency room visits for dry drowning since 2014.

“We had two cases in 2014 of ‘dry drowning,’ he wrote in an email. “Both of those were discharged home and lived.”

This year, there have been nine emergency room visits involving children and adults for all types of drowning, with two deaths, Kerth said.

He said dry drowning occurs in maybe 1 percent of drowning injuries, from what he could find through his research. The best data available from the Centers for Disease Control and Prevention and the World Health Organization only breaks down drowning injuries with fatal and non-fatal submersion injuries.

That’s because of guidelines for data reporting on drowning set in 2010 by the American Heart Association, Kerth said. The guidelines advise against using “ambiguous or confusing” terms, such as “dry drowning” or “near drowning,” because they can be confusing, Kerth said.

Kerth said he would tell parents to be much more worried and vigilant about drowning because a child is much more likely to be injured by regular drowning than dry drowning.

“I would never tell parents to keep little Johnny out of the water or prevent Sara from going to the waterpark,” he said. “Kids should be kids and enjoy their summers.” But there are safety measures that should be in place.

Fences surrounding pools can prevent an estimated 80 percent of childhood drownings, Kerth said, and watching children closely anytime they are around water is a must — toddlers can drown in as little as 3 inches of water. “Think small bucket of water that kid leans over into to grab something and falls in,” he said.

Redman agreed, noting a different warning circulating around social media is accurate: Drowning often doesn’t look like it does on TV or in the movies.

“Most drowning events can be very quiet and subtle,” he said. “It really can happen very quickly and be very unnoticeable.”

Watch for a child who has his or her head low in the water or mouth at water level; head titled back with mouth open; glassy eyes, unable to focus; who is vertical in the water, not using his or her legs; or who is gasping or hyperventilating. All can be warning signs of drowning.

Parents don’t need to be worried that a child who was splashing happily all day could “suddenly develop symptoms out of nowhere” days later, Redman said. They do need to worry that, when water is involved, something serious and tragic can happen in an instant.

“Supervision is always key,” he said. “Always have someone dedicated to keeping eyes on kids in the water.”

Staff writer Rosana Hughes contributed to this story.

“Dry drowning” occurs in maybe 1 percent of drowning injuries, according to research.

– DR. MATTHEW KRETH, CHILDREN’S HOSPITAL AT ERLANGER