The recent tragic death of a child in Texas has prompted widespread reporting on ‘dry drowning’. As parents plan summer holidays, this very sad event represents every parent and carer’s worst nightmare. It is important, therefore to understand what drowning is, what the risks are and how best to prevent drowning from happening.
The 4 year-old boy, Frankie, who very sadly died in Texas was reported to have developed vomiting and diarrhoea a few days after swimming in the Texas City Dike. My heartfelt sympathies go to his parents who are bravely talking about what has happened to prevent other parents suffering the same. Doctors informed the parents that fluid had been found in Frankie’s lungs and around his heart and that he had died from ‘dry drowning’. Parents and carers have therefore been advised that ‘dry drowning’ can happen hours or days after swimming. It can also occur if children breathe in a ‘few gasps’ of water and that this may go unnoticed by those supervising them in the water.
Naturally, this has caused worry and prompted many to question whether we should be taking young children swimming? With swimming lessons for very young children often involving submersion, understandably parents and carers are concerned that they are exposing their children to significant risk. As plans for summer holidays often revolve around booking somewhere with a swimming pool, we should all be aware of what can be done do to minimise risks of drowning and help those in trouble.
What is drowning?
Drowning is the second most common cause of accidental death in children aged under 5 in England and remains an important preventable cause of death in children. Drowning is defined medically as ‘the process of experiencing respiratory impairment from submersion/immersion in liquid’. This means that drowning occurs when the lungs and breathing are compromised by the body either being partly or fully under water. Very little water actually enters the lungs during the drowning process and may be why the term ‘dry drowning’ was coined. The upper airway, the larynx may go into spasm and stop water from entering the lungs. Small amounts of water that do enter the lungs can be absorbed by the body. The harmful effect of drowning is through lack of oxygen getting to the brain as the person is unable to take a breath.
What does drowning look like?
Drowning does not look like it does in the films: no dramatic calling out or waving of arms. In fact drowning is silent as the person is unable to call out for help; they will be using any time their mouth is out of the water to take a breath before their mouth goes under again. They will be using their arms at the level of the surface of the water, or just under to try and keep themselves afloat and so will not be able to wave to attract attention. This does not mean someone who is shouting for help or waving is not in trouble, but many are unaware that someone not doing those things can be drowning. Other things to look out for are closed or ’empty’ eyes, not kicking legs, hair over forehead or eyes, appearing to climb an invisible ladder and not being able to get towards where they seem to be swimming to. There is only between 20 and 60 seconds of struggling like this before they will become submerged.
Drowning can vary in it’s effect so that it can result in death, can cause someone to be very unwell, only affect someone to a minor degree or not at all. Symptoms of drowning include excessive coughing, abnormal breathing or someone not seeming themselves after being pulled from the water. If any of these occur then urgent medical advice should be sought.
‘Dry drowning’ is not a medical diagnosis and a recent article in the Emergency Medicine News has sought to set the record straight to help provide accurate advice and information on drowning to the public and healthcare professionals.
If there are symptoms after someone has been partly/wholly under water, even minimal, then they advise that medical advice should be sought. Minimal symptoms would be anything more than those we get when ‘water goes down the wrong way’. They advise this because research has shown that a person can die from drowning in 1 in 200 cases where someone has mild symptoms, and 5 in 100 where someone has moderate symptoms after being rescued by a lifeguard. Thankfully, a period of observation in hospital may be all that is required as any worsening of symptoms can be monitored and treated. Those who improve can safely be sent home.
Importantly, they advise that someone who has been without symptoms for more than 8 hours after having an incident in water and then develops symptoms is not suffering from ‘dry drowning’ but may be unwell for another reason (and so should seek medical advice). This is important as parents can be reassured that their child is OK if the child seems to be their normal self after being submerged and is not breathing abnormally or coughing after that initial ‘water going down the wrong way’ response has resolved.
How can we prevent drowning?
Most importantly, there are many ways in which we can prevent drowning from happening. These include constant supervision of children in water even if lifeguards are present, touch supervision for toddlers, enrolling children in swim lessons, using life-jackets, four-sided fencing for swimming pools with a locking gate and teaching children how to be safe in and around pools. They should be taught not to push other children or jump on others in the pool or run around the edge of a pool. Remember also that teaching children to swim does not make them drown-proof. The Royal National Lifeboat Institution (RNLI) provide advice on their website about how to stay safe in open water and there is more information on the Fire Service website.
There are also free Swim Safety sessions run by the RNLI and the ASA, who are the national governing body for swimming and promote swim safety. The ASA have recently published new guidelines about baby and toddler swimming. They are in partnership with the Register of Aquatic Professionals where you can check if your child’s swim instructor is registered.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.
Links and Further Reading
- Hawkins SC, Sempsrott J, Schmidt A. Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning. Emergency Medicine News. Published online, available via: http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?PostID=377
- Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 1997;112:660-665. Available online via: http://journal.publications.chestnet.org/article.aspx?articleID=1070900
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