signs of secondary drowning
Though rare, secondary drowning can be fatal if warning symptoms are ignored

Secondary drowning, or dry drowning, can be alarming for many parents. The term refers to delayed symptoms caused by inhaling water into the lungs while swimming

When a child inhales even a small amount of water into their airways, it may cause inflammation and irritation in the lungs, making breathing difficult. The body sometimes initiates a chemical cascade in response to this injury, which worsens the lung membrane and can cause cardiac arrest or death.

A review of 94 consecutive cases of near drowning in childhood showed that this syndrome occurred in 5% of cases.

Death from delayed drowning may be due to:

  • Laryngospasm (closing of airways because the vocal cords suddenly snapped shut). In some cases, it is due to pulmonary edema or swelling of the inner lining of the lungs in response to the entry of water.
  • Inactivation or damage to the lung surfactant (substance present at lung air interface).
  • Lung edema due to actual entry of water inside air sacs or alveoli.

What are signs and symptoms of secondary drowning?

Secondary drowning may cause the vocal cords to spasm and the airway to close, resulting in choking. Symptoms can develop over minutes to hours after swimming, though it is quite rare. 

Symptoms of secondary drowning include:

What are risk factors for secondary drowning?

Keep a close eye on the child for about 24 hours following a close call in the water. If your child has had a close call in the water, keep an eye on them for about 24 hours.

Risk factors of secondary drowning include:

Head is low in the water and the mouth is at or below water level (very young children may keep their head down or not move their heads at all)

  • Head is tilted back with the mouth open
  • Eyes look glassy or empty
  • Eyes are wide open or shut tightly
  • Hair is hanging over the forehead or eyes
  • Body is in a near-vertical position with little or no leg movement
  • Child is attempting to swim but making little or no forward progress
  • Child is gasping or hyperventilating
  • Child is near (or at) the bottom of the pool

How is secondary drowning treated?

Care for a child who has experienced secondary drowning will depend on the situation surrounding the event and how they have responded to pre-hospital care:

  • The initial approach will be to stabilize vital signs by addressing the airway, breathing, and circulation (ABCs) to make sure the child is breathing, has a good heartbeat, and adequate blood pressure to circulate blood to the organs of the body. Some kids may need ventilator assistance in the initial period.
  • If the drowning occurred because of an injury, those injuries need to be assessed at the same time the child is being evaluated for the consequences and complications of drowning (injury to the brain, head, heart, and lungs).
  • If a medical illness has caused the drowning (for example, a seizure or heart attack), the underlying illness will need assessment and treatment.
  • Supportive care is often required for the lungs because they can become inflamed due to aspiration (inhalation) of water during drowning.

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Medically Reviewed on 6/16/2021
References
Cantwell GP. Drowning. Medscape. https://emedicine.medscape.com/article/772753-overview

Pearn JH. Secondary drowning in children. Br Med J. 1980;281(6248):1103-1105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1714551/?page=2