Water dangers can extend to dry land

June 11, 2018 Elizabeth Meade, MD


  • Watch your child even after he or she leaves the water.
  • If water in the mouth gets into the airways, the child could be risking aspiration pneumonia.

With the arrival of warm weather, you and your kids are likely to spend some time in the water, whether rafting, swimming, kayaking or simply splashing in a kiddie pool.

Chances are, you know the basics of family water safety. Do not let young children swim unattended, don’t mix alcohol and water play, don’t jump into dangerously cold water and always have adult supervision when flotation devices are being used.

But have you heard of “dry drowning”? That’s the phrase that recent news reports used in a couple of cases in which children died, or nearly died, days after water in the mouth got into the airway. It’s not really a medical term — the World Health Organization, the American Red Cross and other authorities discourage calling such cases “dry,” “delayed” or “secondary” drowning. Nevertheless, the cases illustrate serious problems that parents should watch for when their children go swimming or play water sports.

What to watch for

In two widely reported cases, a 4-year-old Florida girl and a 4-year-old Texas boy developed symptoms in the days following swimming. The boy died, but the girl was treated and recovered.

Their symptoms included: 
  • Vomiting
  • Difficulty breathing
  • Sleepiness or fatigue
  • Racing heartbeat
  • Persistent coughing
  • Soreness
  • Diarrhea

In the girl’s case, the mother knew she had aspirated pool water when she and a playmate both blew into opposite ends of a hollow swim tube at the same time. The girl threw up immediately and then seemed fine with no further discomfort; however, two days later she developed a fever that would not go away.

The girl recovered after her mother rushed her to urgent care. But medical help came too late to save the boy, who died hours after he inhaled water. 

These two cases show the typical time frame in which symptoms typically present in a near-drowning incident — anywhere from right afterwards to hours or even days later. But even if they seem all right, any child who has come close to drowning should be taken to their pediatrician or other physician for a thorough medical examination. And, needless to say, if your child shows signs of respiratory distress or other unusual symptoms, see a doctor immediately. 

What happened?

The Florida girl was diagnosed with aspiration pneumonia, which occurs when liquids, food, vomit or other substances are aspirated — breathed into the airways or lungs — instead of being swallowed into the esophagus and stomach. News accounts called her case “dry drowning.” The president of the American College of Emergency Physicians addressed this last year, after the death of the Texas boy.

"Parents are being unduly alarmed by media reports suggesting that children can die from drowning a week after swimming," said Rebecca Parker, M.D. "Some children can experience complications from swimming.  For example, it is possible for a child to inhale water and develop an infection, such as pneumonia, which can become very serious and cause breathing problems.  If a child has breathing problems at any time, the parent should take him or her to the emergency department.  But there are no cases of completely normal asymptomatic patients who suddenly die because they went swimming a few days ago.”

Parents do need to pay attention if their child comes down with a persistent cough after swimming or water play. Fluid in the lungs can cause infections or swelling, which causes difficulty breathing. The U.S. National Library of Medicine lists causes, symptoms, risk factors and treatments, which vary according to the age and health of the patient.

By all means, have fun and enjoy your family’s time in the water. But practice water safety and pay attention if your child complains or shows pneumonia-like symptoms such as coughing, fever, difficulty breathing, or vomiting. If she does, seek medical care immediately.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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