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Dry or Secondary Drowning

Jun 11, 2017

Dry drowning

Dry Drowning — a rare, but potentially deadly condition — is on the minds of countless parents after a 4-year-old Texas boy died a week after his family went swimming.

When his 4-year-old daughter ingested water while in a kiddie pool on a family vacation, Dr. Sanjay Mehta's concern about the incident didn't stop after she coughed up water.

Mehta watched his daughter closely over the next day until it was clear to him that there were no lingering effects from the pool water.

But don't chalk up his reaction as an overly worrisome parent. Both doctors and lifeguards are asking parents to be informed about "dry drowning," a rare, but potentially fatal reaction the body can have to what many may see as a harmless water mishap. It's also called "secondary or delayed drowning,"

"She was asymptomatic," said Mehta, a board-certified pediatrician and division chief of CentraState Medical Center's Pediatric Emergency Department. "But I definitely wasn't going to be shy about going in (to the emergency department)."

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Dry drowning has come into the spotlight (in 2014) after a California mom's blog post about her 2-year-old son's harrowing experience went viral.

The condition can be confusing, in part, because of the terminology behind drowning, an incident that many in the general public associate with a person dying.

The World Health Organization defines drowning as a "respiratory impairment from either an immersion or submersion in a liquid." Medical professionals then break those incidents into either fatal or nonfatal drownings.

There were 3,602 unintentional drowning deaths in 2015, the latest year for which data is available, according to the U.S. Centers for Disease Control and Prevention. Of those, 636 where children 14 and younger.

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That same year, the CDC estimates another 9,816 people were treated for nonfatal drownings, of which 5,549 were 14 or younger, according to CDC data.

Secondary drowning is the damage to the lungs, which causes problems for the patient to get the oxygen he or she needs to breathe.

Data is not available on how frequently dry drowning occurs because it is not tracked. Mehta estimates he'll see several cases over the summer, roughly one a month.

Gene Hession, the lifeguard training officer for Long Branch and the president of the Monmouth County chapter of the U.S. Lifesaving Association, said he's seen it happen two times in the more than 40 years he's been a lifeguard.

What to look for:

But experts say what parents should keep in mind is that the effects might not appear for hours after the initial drowning.

"I think the take-home point is if there is ever some sort of submersion event or an immersion event, don't just let it go. Keep an eye on the child," Mehta said. "If there are any symptoms period, seek immediate attention. Don't wait."

Those symptoms include persistent coughing, difficulty breathing, a child's face or lips changing to blue, purple or white, or the child just seeming lethargic.

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All are signs a child's oxygen levels might be low. Caught in time, a child can be given oxygen or more advanced methods of resuscitation if needed.

The symptoms might not be as apparent to parents or they could be interpreted as something else, like a cold developing or asthma, Mehta said. But the key difference parents have to remember is if an incident occurred with water earlier that day or potentially as long as 72 hours prior, he said.

"If there was some sort of event involving water, they should go to the emergency department. Talk to their doctor, but also go to the emergency department to be evaluated," he said.

Hession, the lifeguard training officer in Long Branch, is even sterner in his warning to parents. Any time a child ingests water in a mishap at the beach, the policy is to go to the emergency room.

"You can't be too careful with that. You think they're alright and three hours later, they're dead," he said. "We exercise extreme caution. If a kid swallows water, he's going to the ER, no ifs, ands or buts."

What happens to the body:

Even a small amount of water can cause dry drowning.

As little as 1 to 2 milliliters of water per kilogram in a child's weight — a little less than an ounce for a 3-year-old — can cause a body to react, said Dr. Sanjay Mehta, a board-certified pediatrician and division chief of CentraState Medical Center's Pediatric Emergency Department.

So what exactly is happening in the body?

The water can cause one, or potentially all, of three responses, Mehta said.

The water, including chlorinated pool water, can irritate the surfactant, a liquid coating of the lungs that keep them functioning. The water can either wash out or keep the surfactant from forming.

It can also cause bronchospasm, a tightening of the muscles around the bronchial tubes in the lungs, which constricts the airways and reduces a person's ability to get oxygen.

The body can have a systematic reaction to the water. The blood vessels in the lungs can become leaky and cause pulmonary edema, or a build up of fluid in the lungs, which reduces the ability to breathe and could cause a person to drown in their own bodily fluids.

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