In a harrowing 2014 blog post, writer Lindsay Kujawa described her family's brush with secondary drowning after her son, Ronin, slipped into the water for maybe 20 seconds at a pool party. At first he seemed fine, if a bit shaken. But hours later, Ronin was being rushed to the hospital in an ambulance while his mother helplessly watched his oxygen levels fall. Though he recovered, Kujawa wrote that she was "forever changed since this happened."
"Before [that day] I had never heard of secondary drowning," she continued. "If I had heard of it before, I would have done things differently." With that in mind, and with summer swim season upon us, here are five basics about dry and secondary drowning all parents should know:
1. They occur out of the water.
Both dry and secondary drowning are considered atypical types of drowning in that they occur after a child has been pulled out of the water. In dry drowning, water is swallowed, but doesn't enter the lungs. It does, however, enter the airway, causing it to spasm, which can lead to difficulty breathing and even suffocation, explained Dr. Mark Zonfrillo, a pediatric emergency physician with The Children's Hospital of Philadelphia.
Secondary drowning, on the other hand, takes place when water actually enters the lungs, he said. It too can lead to potentially life-threatening breathing issues.
2. It's important to be watchful for hours.
Dry drowning usually happens within minutes after a child has struggled in the water, but when secondary drowning occurs, a child may not show signs of distress for hours, or -- in rare instances -- even up to a day. "It might not cause any effects immediately, but [secondary drowning] can cause edema or swelling of the lungs in a delayed fashion," Zonfrillo said. And because the precipitating event may not necessarily look especially dramatic -- say, a toddler slips under water for a few seconds -- it's especially critical that parents pay attention to how their child responds after.
3. Look for coughing and fatigue.
"The biggest things to look at are the level of activity, trouble breathing and coughing," explained Dr. Vincenzo Maniaci, a pediatric emergency medicine specialist at Nicklaus Children's Hospital in Miami, Florida.
"If your child is suddenly sleepy and that seems unusual for the level of activity they had, that's a sign to seek medical attention," Zonfrillo echoed. Time is important when it comes to treating dry and secondary drowning, he emphasized, and doctors will want to check and continuously monitor vital signs, get a chest X-ray and possibly provide acute interventions, like administering oxygen.
4. Thankfully, both types of drowning are relatively uncommon.
"These types of drowning only compose about 1 to 2 percent of all drowning incidents," Zonfrillo said. "They're equally scary, but extremely rare." While it's important that parents know what to look out for, he said he hopes news coverage (like this story) will not cause an undue sense of hysteria or worry.
5. There's actually a lot parents can do.
Parents can play a huge role in preventing all types of drowning -- typical, as well as secondary and dry -- Zonfrillo said. Provide constant and targeted supervision when children are near open water, he recommended. "Know exactly who is watching [him or her]," Zonfrillo said. "Make sure you understand the child's swimming skills, and keep in mind that drowning happens very quickly and not how it's usually portrayed in the media -- there's not a lot of splashing, it happens very silently."
Safety measures like pool gates and door alarms are important, echoed Maniaci, as is early enrollment in swim lessons. He said children under the age of 5 can be particularly vulnerable, because even if they know how to swim, they can become easily panicked if they swallow water. (Drowning is responsible for more deaths in kids age 4 and younger than any other cause except congenital anomalies, the CDC reports.)
"If I had a take-home point it would be that every child should have one adult responsible for what they're doing," Maniaci urged.
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