The nation was saddened and horrified last week over reports that a four-year-old Texas boy had died from a suspected case of “dry drowning,” nearly a week after he spent time playing in Galveston Bay. Frankie Delgado seemed fine after being knocked down by a wave and inhaling some water, his parents told local news outlets—but doctors say the incident may have affected his respiratory system and contributed to his death. The official cause of Frankie’s death has not been confirmed.
Meanwhile, a family in Colorado read about the Delgado’s tragic story and realized that their own two-year-old son was having similar symptoms after swallowing water, People reported on Friday. Garon Vega rushed his son to the hospital, where doctors reportedly told him the boy “would not have made it through the night” if he hadn’t been treated.
Even just one highly publicized case of a rare health risk can cause people, especially parents of young kids, to be on edge—let alone two apparent cases within one week. For a bit more perspective, we spoke with James Chamberlain, MD, division chief of emergency medicine at Children’s National Health System in Washington, D.C.
Chamberlain was not involved in either of the cases mentioned above, but he has treated children for symptoms that could be described as dry or secondary drowning. Here’s his take on these scary-sounding conditions, and how worried we should really be.
What exactly is dry drowning?
First, it’s helpful to understand that dry drowning is not an official medical diagnosis. In fact, doctors tend to shy away from using the phrase.
In 2002, an international group of experts defined drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” The group also decided that the term dry drowning should not be used, since the actual cause of death in cases described as such is often unclear. (The term secondary drowning should also be avoided, the group decided, since it could imply a second submersion in water.)
But technicalities aside, these terms are still used. And the phenomenon they describe—in which a person, usually a child, experiences respiratory distress hours after swallowing or inhaling water—does exist, says Chamberlain. In fact, he says, dry drowning and secondary drowning are actually two different things.
During secondary drowning (also called delayed drowning), 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,” Chamberlain says. “The lungs are getting inflamed and you’re basically seeing delayed effects of drowning.”
Dry drowning, on the other hand, implies that a person has swallowed a lot of water, but it hasn’t actually gotten into their lungs. “Usually kids just vomit it up and they’re fine,” Chamberlain says, “but occasionally a child will get inflammation of the airway or some fluid in their lungs as a result of the obstruction when they were underwater and weren’t breathing.” This can cause airways to spasm and possibly close up, even after a person is submerged.
Is it as scary and sudden as it sounds?
When sudden deaths are attributed to these rare conditions, they often make the news. In 2010, for example, a South Carolina 10-year-old suffered cardiac arrest hours after splashing around in his neighborhood pool, and a Pennsylvania teenager collapsed and died 90 minutes after going underwater during a high school swim class.
But typically, neither dry or secondary drowning comes on suddenly, says Chamberlain. “These things aren’t easy to miss, and it’s noticeable within hours that something is wrong,” he says. “Parents don’t need to be worried, if their child is acting fine and breathing fine, that something awful is suddenly going to happen.”
Michael McHugh, MD, acting chair of the pediatric critical care unit at the Cleveland Clinic, told the Washington Post last week that it was premature to classify Frankie Delgado’s death as any type of drowning. Chamberlain agrees, and says being briefly underwater six days earlier is generally unlikely to cause the death of an otherwise healthy child.
The Delgados did tell news outlets that Frankie had vomited, had diarrhea, and complained of shoulder pain in the days and hours leading up to his death, but that they assumed he had a normal illness—not a life-threatening one. In other instances of delayed drowning, parents have reported that their children soiled their pants, complained of chest pains, or seemed more fatigued than usual before they died.
When should parents worry?
“I would tell parents that if a child has gone underwater and seems to have swallowed or inhaled some water, they should be watched closely for the next 12 hours to make sure they don’t develop shortness of breath or coughing,” says Chamberlain. “If they do, they should be seen by a doctor right away.”
Any child that’s in the water should be closely supervised, he adds. “They should be within reach so you can pull them up if they get knocked over,” he says. “But if they do go under briefly and they sputter and cough a bit, that’s not a reason to panic.”
To put the risk in perspective, consider this: About 3,500 people die from drowning every year in the United States, and about 700 of those deaths are children. The Centers for Disease Control and Prevention doesn’t keep statistics on dry or delayed drowning specifically, but Chamberlain says about 1 percent of those deaths—about seven children a year—would be expected to have some type of “delayed” component.
Meanwhile, about 300 people die from lightning strikes each year, he says, “so even lighting is a more common threat than this kind of rare post-drowning event.”
Of course, parents should watch their kids closely after spending time in the water for any strange behaviors or symptoms. (After all, pools can have health risks even if you don’t inhale the water.) But it’s also not a reason to keep well-supervised kids from enjoying the beach, the pool, or the water park, Chamberlain stresses.
“I think far more important safety risks to be aware of in the summertime have to do with kids not wearing helmets on their bikes or skateboards and not wearing seat belts in a car,” he says. “We see a lot more of those incidents, and preventing those is really just common sense.”