Florida resident Lacey Grace thought she was probably overreacting when she drove her 4-year-old daughter Elianna to an urgent-care facility on April 18. Elianna had developed a fever and had been sleeping a lot over the past few days, but what really concerned Grace was an incident that had occurred in the family’s swimming pool that past Saturday.
The perfectly healthy 4-year-old had been playing with a pool noodle, blowing in one end and shooting water out the other. “By 100% freak accident, Elianna put her mouth to blow out at the same time someone blew in the other end, causing the water to shoot directly down her throat,” Grace wrote in a Facebook post that has since gone viral.
“She threw up immediately but didn’t really have any other notable things happen,” Grace wrote. “Thirty minutes after the ‘accident’ she was totally fine—normal, playing, eating, etc. The next day, even, she was fine.”
I contemplated whether or not this was worth posting, and at the end of the day, I am where I am because of something…
Elianna developed a fever on Monday, but Grace assumed her daughter had simply caught an unrelated virus. As the fever lingered for a few days, though, she decided she’d rather be safe than sorry.
“I kept replaying that pool scene in my head and remembered reading a story last year about a dad in Texas whose son passed away because he went untreated after inhaling a bunch of pool water,” Grace wrote. “I wasn’t going to let that be Elianna.”
Grace's instincts were right: A doctor at the urgent-care center told her to get to an emergency room right away. Elianna’s heart rate was higher than it should be, her oxygen levels were low, and her skin “was turning purple, which suggested chemical infection,” Grace wrote. A chest X-ray at the hospital showed inflammation and infection caused by pool chemicals.
Grace did not use the words “dry drowning” or “secondary drowning” in her Facebook post. But as Elianna’s story has gone viral and been picked up by the media, those terms have become attached to it—just as they have with other recent stories involving children’s fatal (or near-fatal) encounters with water in a pool or bay.
Last year, after two such events, Health’s sister publication Real Simple spoke with James Chamberlain, MD, division chief of emergency medicine at Children’s National Health System in Washington, D.C., to learn more about these terms. Today, Health also checked in with James Callahan, MD, emergency medicine physician at Children’s Hospital of Philadelphia. Here’s what these experts want parents to know.
What are "dry drowning" and "secondary drowning"?
The terms “dry drowning” and “secondary drowning” are not medical diagnoses, Dr. Chamberlain told Real Simple. In fact, an international group of experts decided in 2002 that both terms should be avoided because the actual cause of death in these cases is often unclear. In addition, a term like “secondary” drowning could imply a second submersion in water.
Informally, though, the terms are used to describe respiratory distress hours (or longer) after swallowing or inhaling water. “Most people who have submersion injuries have symptoms right away,” explains Dr. Callahan. “But there are a subset of patients, usually kids, who will have symptoms hours or even days later.”
In most cases, secondary drowning—also called delayed drowning—refers to when a person chokes on fluid in the lungs but seems okay immediately afterward. “But over the next few hours to 24 hours, you develop shortness of breath and you might cough and wheeze,” Dr. Chamberlain said. “The lungs are getting inflamed, and you’re basically seeing delayed effects of drowning.”
Dry drowning, on the other hand, usually implies that a person has swallowed (rather than inhaled) a lot of water. “Usually kids just vomit it up and they’re fine,” Dr. Chamberlain said. “But occasionally a child will get inflammation of the airway or some fluid makes its way into their lungs.” This can cause airways to spasm and possibly close up later on.
Dr. Callahan says that, while these are two different conditions, they have a lot of similarities. “What it’s called and which one it is technically isn’t as important for parents as just being very careful about kids around water,” he says, “and doing our best to prevent all types of submersion injuries.”
How much should parents worry?
According to Grace’s Facebook post and subsequent media interviews, Elianna was officially diagnosed with aspirational pneumonia secondary to pool water ingestion. She remained in the hospital for four days, relying on oxygen tubes to breathe and receiving antibiotic treatments as her heart and lungs recovered from the ordeal.
“At least two doctors have now told us, ‘Thank God you got her here when you did,’” Grace wrote the day after her daughter was admitted to the hospital. “All the major things going wrong are things you would NEVER notice by looking at her.”
She warns other parents to “immediately get help” if their kids inhale water and they notice anything that “seems off AT ALL” afterward. “I thank my lucky stars that I read that article of the little boy,” she wrote, promising to write a letter to the boy’s father. “I would have never taken her to the urgent care without that, and God only knows how this would have ended.”
Dr. Chamberlain agrees that parents should watch their kids closely after they spend time swimming or playing in water, especially if they’ve been submerged or seem to have swallowed or inhaled any water. While some signs of danger may be subtle, they can also include coughing, shortness of breath, chest pains, and children soiling their pants.
Dr. Callahan says that anytime a child has been submerged and needs to be assisted out of the water, he or she should be checked out by a physician. “Or if a child just doesn’t seem to be acting right in the next day or two—he’s sleepier than usual or seems confused or is having trouble speaking—those are warning signs he should be seen by a pediatrician,” he adds.
Still, parents shouldn’t freak out every time their children get some water up their noses while swimming or splashing around, says Dr. Callahan. He points out more than 700 children die every year from drowning and estimates that “probably less than 1%” of those deaths have this type of delayed component.
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"These delayed events can be serious, but they’re also very rare,” he says. “I really think that paying attention and making sure that pools are fenced, that kids are never swimming alone, that they wear life preservers, and those sorts of things are going to have much more of an impact on keeping kids safe.”