by Mary Beth Schweigert

Tragic drowning deaths like that of a Texas child in summer 2017 put the term “dry drowning” in the spotlight. The story went viral on social media, as frightened parents read about the death of the 7-year-old boy, seemingly out of the blue, a week after swimming on a family vacation.

Experts, including Joan Thode, MD, of Penn Medicine Lancaster General Health Physicians Roseville Pediatrics, maintain that “dry drowning” is a misunderstood term and not an actual medical condition. Despite that reassurance, media stories and social media accounts of near-misses persist in the summer of 2018.

“Unfortunately a lot of misinformation about the idea of ‘dry drowning’ has been shared on social media, causing confusion,” Thode said. “Put plainly, there is no such thing as dry drowning.”

Joan Thode, MD

Media stories used the term “dry drowning” to describe a death that occurred suddenly, hours or days after a seemingly benign swimming event, she said. In actuality, the sudden death occurred due to a rapid inflammatory response to water that enters the lungs, also known as aspiration.

“Water is aspirated only if a child is unconscious or underwater for a significant amount of time,” Thode said. “Kids who go swimming and play normally without either needing to be pulled from the bottom of a pool or having a major, persistent choking or coughing episode will not be at risk for later death, because water has not been aspirated.”

While “dry drowning” might be more hype than reality, drowning is a real threat to children -- and warm weather, pool parties, and family vacations make summer the most dangerous season. In fact, according to the U.S. Centers for Disease Control, drowning ranks second among causes of unintentional death for children ages 1 to 14, behind only motor vehicle accidents.

According to the CDC, two children ages 14 and younger die from drowning every day. And for every child who dies, another five receive emergency care for drowning-related injuries, which can include lung or brain damage.

“Many parents might be surprised to learn that it’s possible to drown and not die,” Thode said. “Medically, drowning occurs when water enters the airway, causing symptoms that can range from relatively mild to moderate breathing problems to lung damage to death.”

In the worst cases, breathing stops following a drowning event, and CPR is required for survival. Significant, prolonged gagging, choking, sputtering, intense coughing and/or gasping can be signs of respiratory impairment that requires medical attention.

Many articles about the drowning death of the Texas child described him as “swallowing” water while swimming, which has caused confusion, Thode said. Most children accidentally swallow a swig or two when splashing around in the water, she said, and most of the time, parents shouldn’t worry.

Water swallowed during swimming goes down the esophagus into the stomach, just like any other food or drink, Thode explained. A few coughs – the body’s typical response when a sip of water goes down “the wrong pipe” – is no cause for concern.

Vito DiCamillo, MD

“A true drowning event, if it presents with choking, will not go unnoticed,” she said. “In these cases, there is significant distress, during which time your child – and you – will be alarmed and probably panicked.”

But Thode warns that a child who is truly struggling in the pool will not splash and carry on, because just keeping their face above water requires all of their energy. In these cases, the child may be found under the surface of the water, because their silent struggle was less noticeable among their splashing peers.

Depending on how long a child is under water, they may experience significant coughing or choking, or lose consciousness, stop breathing and require CPR. Significant coughing after a drowning event is a sign that water has entered the airway and could continue to cause lung damage, Thode said. The medical term for this process is “aspiration.”

After a drowning event, inflammation of the lung tissue can prevent transfer of oxygen to the blood, she said. In some cases, this process can slowly escalate in a drowning victim who seems to recover, eventually becoming an emergent situation in which the lungs cannot function.

“This may help to explain where misconceptions about ‘dry drowning’ originate,” Thode said. “Although this can happen after a swimmer goes home, it is not dry drowning. It is a latent effect of the initial drowning event that happened in the water.”

Vito DiCamillo, MD, medical director of LG Health’s five Urgent Care centers, has treated young patients who have experienced multiple episodes of choking or swallowing water while swimming. Urgent Care providers sometimes also field questions from concerned parents about the possibility of “dry drowning.”

Seeking prompt medical care after a drowning event can help ensure that aspirated water does not cause lung damage, DiCamillo said.

“If a child had a true submersion requiring any type of CPR, they need to go the Emergency Department immediately,” he said. “If they have a less significant ‘choking spell,’ with persistent cough, chest pain, rapid breathing, fever or breathlessness, they should seek medical attention.”

It’s important for parents to know the signs of drowning so they can be proactive about seeking treatment, DiCamillo said. However, prevention is the best defense.

Children should be supervised closely around pools, because they can slip underwater very quickly. The American Academy of Pediatrics recommends “touch supervision,” or keeping a watchful adult within arm’s length of any inexperienced swimmer who is in or around the water.

If your child can’t swim, personal floatation devices are not adequate protection against drowning, DiCamillo said. And because pools can be incredibly attractive to curious children, always keep them gated and locked to avoid unsupervised access.

“It is never too early or too late to teach a person how to swim,” he said.