Parenting • Jun 09, 2014

Dry Drowning: What Every Parent Needs to Know

It’s not often that I beg parents to bring their kids into the ER, but that’s exactly what I did when I heard about a child with a dry-drowning episode.  He knew how to swim but he inhaled some pool water by accident.  He coughed a bit, but a few minutes later was back in the pool.  The child looked fine, the parents reassured me.  It was bedtime, and everyone was tired after a long day in the sun at the pool.  “We’ll let him sleep, and if he’s having any issues in the morning we’ll take him into his pediatrician,” the father told me.

“No, you need to come to the ER now,” I told him.  He didn’t want to believe me.  They reluctantly came, forking over Floating Lifebealttheir $250 ER co-pay with annoyance.  Then I showed them his chest x-ray that revealed extra fluid in his lungs, and his laboratory results including a low sodium level.  The atmosphere in the exam room changed from annoyance to fear.  This was real.  Their child was drowning.

Dry drowning scares me.  The kids can look fine– they just had a little sputtering and coughing episode after a scary moment while swimming.  Occasionally dry drowning can happen in the bathtub.  But sometime within the next 24 hours their lungs start a massive inflammatory reaction to the water they inhaled into their lungs.  Sometimes they need a ventilator to breathe for them, and drugs to keep their blood pressure up.  But the worst cases of dry drowning are the children I never see, the ones who were put to bed and never wake up in the morning.

My patient was ultimately fine– he was admitted to the hospital overnight and treated with oxygen and IV fluids, but by the next day he was well.  He was a lucky one.

There is some debate about the definition of the term “dry drowning”– usually this term refers to situations where some water got in a child’s lungs and the child has a severe inflammatory reaction to the water hours after the incident.  This phenomenon is also called “secondary drowning,” or “near drowning.”  There is another phenomenon, also sometimes called “dry drowning,” in which suffocation occurs but no water ever entered the lungs.  In these rare situations, the larynx (voice box) spasms and stays shut, causing involuntary suffocation.  Sometimes this spasm is triggered by water droplets hitting the larynx, or a sudden high speed submersion under water such as off a high-dive or a high speed water slide.  This latter form of dry drowning generally doesn’t occur when kids are simply swimming or playing in the pool.  These patients are also immediately ill.  They may never come up from the water.

What are the warning signs and symptoms of “dry” or delayed drowning? When do parents have to worry about a child who had trouble while swimming?  These are reasons to bring your child to the Emergency Room, even if they look fine:

  • Coughing: Any person who has persistent coughing after playing in the water is at risk for water in their lungs.  You may be thinking, “but this happened to me a million times when I was a kid.”  But what was your oxygen level while you were sleeping that night?  You may have dropped and no one ever knew.  Don’t go to bed worrying, just take your child in for evaluation.
  • Water rescue:  Any person who was submerged in water and came up struggling, especially if he or she had to be retrieved from the water by a lifeguard, parent, or other bystander needs medical evaluation.  This may seem obvious, but I’ve seen kids get back in the pool and play after a water rescue.
  • Amnesia: Any person who was unconscious underwater or has limited memory of an incident that occurred in water needs immediate medical care.  I had a patient once who had an underwater head injury with loss of consciousness, but finished her swim meet before going to the ER.  I’m just thankful she didn’t drown or bleed into her brain during that second race.
  • Behavior change:  If your child feels sick, acts too sleepy, or has a change in mental status/behavior after a day at the pool, take it seriously.  The worst thing you can do with a child who may have inhaled water is put them to bed.  They need immediate medical care.
  • Vomiting: Vomiting after a day of swimming can be due to waterborne infectious disease (poop in the pool water…), but can also be a sign of severe illness due to dry drowning.

Ultimately, the best way to prevent drowning is to teach kids how to swim.  The best time for swim lessons is about age four.  Children under age four may benefit from lessons to get acclimated to the water, but don’t count on lessons to keep your toddler safe in the water.  Instead, read these 5 tips for safe water fun, quit worrying, and enjoy your day at the pool!


  • Rob

    Father of three and lifeguard for years, I witnessed first hand a 40 years old male fainting, spending no more than 4 seconds in the water and then suffering from secondary drowning.
    Exams showed he had inhaled a super small quantity of sea water, but saline concentration had caused a massive reaction in the lungs.
    Scary for him, his family but also for us attending his case.

  • Mark S.

    Thanks for this post. A new grandfather and have a pool. Needed to read this.

  • My 2 mo old son was taking a bath and accidentally breathed in some water. Now he is acting very sleepy.should I take him in for dry drowning symptoms?

  • jasmine Jones

    My 15 month old child was taking a bath and I was sitting right there watching slid under water for a split second I picked her up there was no reaction, no screaming, crying, coughing or nothing her eyes went to the back of her head but after she was fine..I called her doctor told her everything she asked questions and told me don’t worry she sounds fine but I’m still worried if water got in her lungs cause was no I panicking for nothing????

  • Danielle S

    My 2 year old was swimming today and went under. I grabbed her and she coughed a little bit but seems fine. I’m a paranoid mother and don’t want anything happening to my babies.. should I take her?

  • Derek Stevenson

    My wife doesnt think our 8 month old could drown in the bath if we are right there with him
    She tells me im being to paranoid
    Am I ?

  • Anh

    you are

  • Sarah Eydel

    when i was 4 or something and learned swimming. the “teachers” put my head in the water. was not nice.

  • Danielle Lavoie

    Children can drown in 2″ of water…That warning is on pools, inflatable toys, etc.

  • Danielle Lavoie

    You are wrong. If you look at various warning labels on pools, inflatable toys, etc., it states that children can drown even in just 2″ of water

  • Danielle Lavoie
  • Danielle Lavoie

    Most accidental drownings and near drownings occur in residential
    swimming pools. However, children can drown in 1 to 2 inches of water.
    These drownings frequently occur in bath tubs, buckets, toilets, diaper
    pails and wading pools.