Recently, Lindsay Kujawa of, Delighted Momma wrote about her toddler’s near drowning experience and the aftermath. Her post went viral and the discussion about “secondary drowning” has become a major topic in the media. Luckily “secondary drowning” (which is actually a misnomer but more on that later) is exceedingly rare. What is more important is to get the message out about pool and water safety especially as summer is upon us (finally!).
Accidental death from drowning is the leading cause of unintentional injury in children ages 1-4 years old. It is the second leading cause of unintentional injury in children ages 1 to 14 years old. For every child who dies from drowning, another 5 receive emergency department care for nonfatal submersion injuries, which can result in long term neurological side effects.
Childhood drowning is devastating for everyone involved. It can happen in less than 4 inches of water and in a split second. Luckily, there are many things we can do as parents to help prevent this type of injury. The goal of this article is not to frighten or scare you (I am sure, as parents, we all feel that every day), but to empower you to take the appropriate steps to prevent water related injuries, know how to handle events if they occur and know what to look out for in children with near drowning incidents.
What is drowning?
There are multiple definitions of drowning, nonfatal drowning, wet drowning, dry drowning, secondary drowning, and near drowning that create confusion. There is also a lot of misinformation available to parents. To help simplify things we encourage you to think of it as water events that are in the following two categories: fatal drowning and nonfatal drowning.
Drowning is a general term that refers to impairment of the respiratory system after being submerged in water. Sadly, people can die right away from submersion in the water, and this is referred to as fatal drowning.
Nonfatal drowning is when there is survival, at least temporarily, after being submerged under water. Most of the time, this is very obvious, a child has visible distress, is rescued from the water, may need CPR, and then should go to the hospital immediately. If the child is breathing, but having distress, call 911 right away. If the child is unconscious, follow CPR protocol.
I have heard of “secondary drowning” what exactly does that mean?
“Secondary drowning” is a misnomer and we as a medical community are trying to move away from using this term. What people are referring to here is a delayed response to a nonfatal drowning episode. This refers to an event in the water where only a small amount of water enters the airway when a child is briefly under. The child may gag and cough a little but seem fine for a while and will start to manifest symptoms in the hours following the event. Luckily, these events are exceedingly rare but it is important to know how to monitor your child following this type of event.
What signs should I look out for if my child has a near drowning event?
Observe your child closely. Signs of distress can occur anywhere from 1 to 24 hours following the episode. A child may show the following symptoms:
Coughing or breathing distress: Typically, the coughing would be continuous or uncontrollable and the child would seem short of breath or labored when breathing, and in verbal children may also include complaints of chest pain.
Lethargy or fatigue: A child would seem unusually tired. It can be hard to tell sometimes after a long day at the pool if your child is more tired than usual, but keep in mind that if there was an underwater event you may want to err on the side of caution.
Behavioral changes: For example, irritability or excessive crankiness that seems out of character for your child. You should also monitor for unusual behavior such as an older child urinating or defecting on themselves.
Can this type of drowning be treated?
Yes, these episodes require emergency intervention and should be treated in the hospital. Once in the hospital, children will sometimes need supplemental oxygen or if very sick, may require a breathing tube be inserted to help the child breathe while the lungs have a chance to heal on their own.
Are certain children more susceptible to this atypical type of drowning?
Yes, children with underlying lung problems such as asthma, or those with little or no experience swimming are at slightly higher risk for these events.
What steps can I take to prevent drowning?
Keep a close eye on your children: Parental vigilance when children are near water is essential. ALWAYS know where your child is. Never leave your child unattended in or near water, even if a lifeguard is present. Instruct babysitter and caregivers about potential water hazards and the importance of water safety. If you are in the water with an infant or a toddler always be within arms length of your child and touching them providing what is referred to as “touching safety.” For older children always have an adult who is the “water watcher.” Do not engage in social activities, phone calls, reading, using the computer or chatting with friends while you are the “water watcher.” In a group of larger adults, adults can take turns having this role so supervision stays fresh and the supervisor in not distracted. Just because a child has taken swimming lessons does not mean they cannot drown. NEVER allow children or adolescents to swim alone.
Create a safe pool environment: If you have a pool, (kind of unusual in Brooklyn or Manhattan, though maybe you have a summer home) install a five foot fence surrounding the entire pool. The fence should be hard to climb and have a self-closing and self-latching gate. Families should also invest in rigid pool covers and pool alarms, but be mindful that neither of these should be used to replace a fence.
DO NOT assume that floaties are keeping your child safe. Inflatable floatation devices are not designed to prevent drowning and should never take the place of a life jacket. Never leave your child alone in the pool even if they are wearing a life jacket. Floatation devices should NEVER be used in place of close supervision.
Take an infant and child CPR course. We highly recommend that parents and all child caregivers take an infant and child CPR class. As your children get older, you may want to take refresher classes as well. You will want to make sure you take a class given by a certified instructor and specifically designed for infants and children. If you have a pool, have a phone available near the pool in case of emergency, have CPR instructions posted, and keep a life saving ring and Sheppard’s hook poolside.
Teach your child to swim: The American Academy of Pediatrics states that children may start swimming lessons from ages 1-4. They recommend all children over age 4 take swim lessons. Be vigilant around all types of water: In children under 1, drowning occurs most commonly in bathtubs, buckets, and toilets. Never leave your child unattended around any water. Drowning can occur in small amounts of water and very quickly. Take special precautions in bodies of natural water and on boats. ALL children and adults should wear life jackets when on a boat.