Drowning out of the water

All parents know how important it is to be vigilant whenever their children play in or near a body of water. But did you know that a child can drown several hours after getting out of the water?

We've been warned about riptides in the sea and, hitting your head on the bottom of the swimming pool. We’ve been taught how to identify swimmers in trouble: those whose heads are low in the water with a mouth submerged; or bobbing up and down as though playing hide-and-seek below the surface; or not making progress while appearing to be swimming. But would you be able to recognise dry drowning or secondary drowning?

“The terms dry drowning and secondary drowning are often used interchangeably – even by some experts – but they’re actually different conditions,” explains Dr Mark  Zonfrillo from the Children’s Hospital of Philadelphia. They are both very, very rare. But they can also be fatal.

In the case of dry drowning, the child will have taken in a small amount of water through the nose or mouth while swimming or splashing. The water comes into contact with the larynx and causes a spasm which closes up the airway – this interferes with the child’s breathing. Dry drowning usually happens soon after exiting the water, or might even happen while still in the water. First aid involves tilting the child’s head way back while lifting the chin: this will force open the muscles. You can also move the lower jaw forward: position the child on their back, place your fingers behind the angles of the child’s lower jaw and move it upward while using your thumbs to open the mouth slightly. If that doesn’t work, perform CPR in the hope that the pressure will force the airways open or break the spasm.

Secondary drowning can occur up to 24 hours after a person survives an underwater drowning experience. The child may appear to have recovered completely, but the inhaled water has already been absorbed into the lungs and is busy damaging the delicate membranes necessary to exchange oxygen and carbon dioxide.

It all sounds pretty scary, but fortunately, dry drowning or secondary drowning doesn’t happen out of the blue. “You’re going to see warning signs,” says Dr Sarah Denny from Ohio’s Nationwide Children’s Hospital. Most likely, you will have witnessed your child getting into trouble in the water, or you will have had someone tell you about it. Any child rescued from an incident in the water needs to be assessed by a GP, even if they appear all right. The doctor may need to order a chest x-ray or administer oxygen. In addition, you must monitor the child for 72 hours after the near-drowning event. Be on the lookout for persistent coughing or laboured breathing. Extreme fatigue, forgetfulness, chest pains, changes in behaviour, and vomiting are all signs that the child is not getting enough oxygen and should receive immediate medical assistance.

In the good news department, paediatrician Dr Peter Jung advises us not to panic, as the majority of dry or secondary drowning incidents “happen where it is clear that the child has been submerged under water. Dry drowning is a real risk but a very unlikely one if you follow safe water practices.”

prevention

  • Encourage your children to tell you about any incidents that may have occurred during water play.
  • If your child has had a near-drowning episode, make sure they are checked by a GP. Don’t let them rest on their back, as that position will encourage the water to spread throughout the lungs. Don’t let them fall asleep in case you miss the symptoms of secondary drowning.
  • As for other types of drowning, practise water safety. Monitor kids closely in and around the water. Teach them to be water-wise: swimming lessons, wearing flotation devices, knowing what to do if they fall into the pool.

shallow water blackout

Teach your children never to hold their breath while swimming or practice breath-holding underwater, because this poses a risk of passing out due to lack of oxygen.

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