What Parents Need to Know About Dry Drowning

Dr. Christian Wright is an Assistant Professor of Pediatrics at the University of Maryland School of Medicine and specializes in pediatric emergency medicine at the University of Maryland Children’s Hospital. Below he answers everything parents need to know about “dry drowning.”

What is dry drowning?

“Dry drowning” is actually an outdated term. These days, research and health organizations prefer to simply define drowning as a process where being submerged or immersed in liquid leads to respiratory impairment—that is, difficulty breathing. Drowning can be fatal or nonfatal. Sometimes a person can develop difficulty breathing after they have left the water, sometimes even hours later, and sadly there have been cases when children have died of drowning hours after being exposed to water.

In the media, a distinction is often made between “dry drowning” and “secondary drowning.” Again, these are outdated terms, but they do attempt to explain two physiological processes that occur in drowning.

When water is inhaled, it causes a spasm of the airways which causes them to close, which makes it difficult to breathe. This usually happens right after the water has been inhaled, so the person could still be in the water or they could have just left it. In the past, it was thought that in this way a person could drown without water entering the lungs, so this was called “dry drowning.” In reality, though, water enters the lungs in almost every drowning death.

When water gets into the lungs, it interferes with our lungs’ ability to exchange oxygen and carbon dioxide, so oxygen levels in the body drop. Water also washes out surfactant, which is a substance in our lungs that prevents the small air sacs (alveoli) from collapsing when we exhale. This leads to pulmonary edema, or a buildup of fluid in the lungs, and difficulty breathing. A child could develop these symptoms up to 24 hours after exposure to water, and in rare cases this results in death. This has been referred to as “secondary drowning,” though it is really just the culmination of the drowning that started when the child was in the water.

How common is it?

“Secondary drowning” is rare, so there aren’t good statistics about how frequently it happens.

What are the symptoms?

Any time water enters our airway, our body has reflexes that kick in to clear the water. So a child could have coughing, gagging or difficulty breathing. Usually, this is sufficient to clear the airway. However, if water got into the lungs, the child could develop symptoms hours later. These include coughing, difficulty breathing, chest pain, vomiting, irritability or fatigue.

How does someone become a victim of dry drowning?

Any time water is inhaled, it could cause delayed symptoms. This could be after swimming or bathing or even after a short exposure to water like being dunked or the face being submerged in a puddle.

How’s it treated?

Drownings are treated by monitoring lung function and treating as necessary. A patient without symptoms may only need to be monitored. Patients with symptoms will need to have their lung functions monitored and supported. They might need supplemental oxygen, noninvasive forms of ventilation like CPAP, or a breathing tube may need to be placed. These patients will need to be monitored until their symptoms go away and their lungs are working normally again.

What’s the best way to prevent dry drowning?

The best way to prevent “dry drowning” is to exercise good water safety principles, including the following:

  • All children should be closely watched whenever they are are in or near water. Never leave children unattended near water.
  • Swim where there is a lifeguard, but don’t rely on the lifeguard alone to watch your child—continue to closely monitor your child.
  • Make sure pools are properly fenced and guarded. Fences should completely surround the pool area, be at least 4 feet tall, and gates should be self-closing and self-latching.
  • Teach teenagers the dangers of drinking alcohol while engaging in water activities.
  • Teach children to not roughhouse in the water
  • Enroll children in swimming lessons as early as possible
  • Have young or inexperienced swimmers wear U.S. Coast Guard-approved life jackets
  • Learn CPR

To learn more about Pediatric Emergency Medicine at the Universtiy of Maryland Children’s Hospital, please click here.