Is dry drowning real?
What are dry and secondary drowning? And do we really need to worry about them?
Every summer, it seems like new and frightening cases of “dry drowning” or “secondary” drowning pop up on TV shows, news reports and social media. These accounts are often accompanied by claims that a child can die days or even weeks after a scary water-related incident.
But what are dry and secondary drowning? And do we really need to worry about them?
Unpacking misleading terms about drowning
Although they lack a medical definition, the terms “dry,” “delayed,” “secondary,” “near,” “wet,” “active” and “passive” drowning are frequently used both by providers and the lay media to describe patients who have some degree of respiratory difficulty after being in the water but are still alive. Here are some of the commonly used terms:
- Dry drowning: You may have heard this term used to incorrectly describe a drowning on dry land that occurs sometime after being immersed in water. Dry drowning was also a medical term used to describe drownings where a person is underwater, but it does not enter the lungs. It was once thought that in these cases the airway would close (a condition called laryngospasm) and a person would suffocate. However, laryngospasm rarely is the primary cause of drowning—when a person loses consciousness while drowning, the airway opens up again. Plus, regardless of whether water enters the lungs or not, it is still considered drowning, because it was caused by water immersion.
- Secondary drowning: Sometimes also referred to as “delayed drowning,” this term is used to describe water entering the lungs with symptoms of drowning worsening over time. Some stories claim symptoms can appear days later, but in those cases, they’re likely due to another cause. This term is also confusing because it incorrectly implies that drowning victims have gone through a second immersion under water.
- Near drowning: Because drowning is typically associated with death, “near drowning” has been used to describe a drowning incident that the person survived.
The World Health Organization (WHO), International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA) and all other major resuscitation bodies define drowning as the process of respiratory impairment after submersion or immersion in liquid, with outcomes ranging from no injury to death. Drowning is a process, not an outcome.
Most importantly, drowning is caused by lack of oxygen, not the amount of water entering the lungs, as is often believed. In other words, the terms above miss the point and simply don’t make any medical sense.
So, why are these misnomers so widely used? In common use, we equate the term “drowning” with death and struggle to describe the scenario in which someone drowns but does not die. But there is a medically accurate term for these cases: “non-fatal drowning.”
What is non-fatal drowning?
Although there are approximately 4,000 fatal drownings in the United States each year, non-fatal drownings are far more common. In fact, it’s estimated that for every fatal drowning, there are at least five non-fatal drownings that require medical care. Some international studies report as many as 10 non-fatal drownings for every fatal drowning.
Though we commonly think of all drowning persons as having been completely under the water (submersion), drowning can also occur if there is respiratory impairment from water splashing in the face (immersion). Drowning incidents happen during whitewater rafting, as well as in heavy ocean surf, wave pools or waterslides, where the person takes in water even though their head is above the water.
After someone is rescued from the water, look out for symptoms like coughing, wheezing or lightheadedness. If you also begin to notice more severe ones like irritability, confusion, headache, lethargy, vomiting, respiratory difficulties or unconsciousness, seek emergency medical care.
Even if the person is experiencing mild drowning, it’s important to take them to the doctor or emergency room so they can be observed for a few hours. An easy rule of thumb is to seek medical care if the person is having more respiratory difficulty than expected from something going down the wrong pipe.
Keep in mind: A drowning victim’s condition will not deteriorate days or weeks later without any symptoms. Respiratory or neurologic symptoms will be present as soon as they get out of the water and will either get better or worse over the next few hours. There are no published cases of someone being 100 percent normal, then later having a deterioration. If someone develops symptoms days or weeks after swimming, seek medical care.
If concerning symptoms develop more than eight hours after leaving the water, then you should still seek care, even though it was not caused by the drowning event.
Water safety tips to avoid drowning
According to the Centers for Disease Control and Prevention (CDC), drowning is the leading cause of death in children age 1 to 4, aside from birth defects. It’s also the second leading cause of unintentional injury-related death in children age 1 to 14. But it can occur at any age due to a variety of risk factors.
Some ways to reduce drowning risk include:
- Supervising your child at all times: Children younger than 5 years old should be under constant supervision around any amount of water, not just places like bathtubs and pools. Toilets, sinks, buckets, puddles, coolers with melted ice, trash cans and wading pools can all pose a drowning threat. Containers filled with water should be emptied immediately. Young kids should be under “touch supervision,” or within reach at all times. Older kids should be under uninterrupted supervision, meaning adults shouldn’t be reading, napping, looking at their phone, eating or performing any other distracting activities while their child is swimming.
- Creating barriers: Using secure pool fencing, load-bearing pool covers and locks on pool access points can prevent unsupervised access.
- Enrolling your child in swim lessons: Formal swimming lessons have been linked to reduced downing risk in children age 1 to 4.
- Learning CPR: Parents should enroll in a CPR class and encourage family members, babysitters or anyone else who may supervise their child to do so as well. Kids age 1 to 4 are at the highest risk for drowning when they’re not being supervised by their primary care provider.
- Wear a lifejacket: Even if you have strong swimming skills, life jackets can reduce the risk of open-water and boating drownings.
- Stay alert in open water settings. There is a risk of drowning in lakes, rivers and oceans for both children and adults, often due to inability to predict currents in open water. If waves look too rough or water is moving too quickly, don’t swim. Obey all beach flags, especially when they advise against going into the water.
- Avoid alcohol when swimming: A cold beer at the beach may sound relaxing, but drinking before swimming, boating or participating in water sports increases the risk of drowning. Adults supervising kids around water should never consume alcohol.
- Supervise elderly family members in the bathtub: Rates of elderly drownings are rising due to the sedative effects of certain medications. It’s important to supervise elderly family members while they’re in the bathtub or pool. Use similar care with people who have seizure disorders or other medical conditions where loss of consciousness can occur.
The best way to treat drowning is prevention. Remaining vigilant and taking the proper steps to reduce the risk of drowning can protect you and your loved ones from both fatal and non-fatal drowning. If somebody does experience drowning, don’t delay care.