During the summer, drownings are a significant concern among pediatricians and other medical professionals who care for children. Death and disability from drownings are legitimate fears and, unfortunately, are not rare. With this in mind, misunderstandings about drownings can occur, and families can be misinformed by what they see from various sources.
There are only two acceptable ways to describe drownings: fatal and nonfatal. Prior terms of near-, dry, secondary, and delayed drownings are inaccurate. A person either survives the drowning or does not. Survival with or without permanent injury is still termed a nonfatal drowning. Those who do not survive the drowning, either immediately or during some time afterward, suffer a fatal drowning.
A dry drowning implies that a person drowns without having water in their lungs. The concept evolved from individuals found dead in the water without fluid in their lungs. The underlying drowning concept is based on water being aspirated into the lungs and causing lung dysfunction to the point of not being able to move oxygen into the blood. So, having no fluid in the lungs usually means that person died from something else and happened to be in the water at the time. Sure, there is the concept of the larynx spasming closed after being triggered by water trying to enter the airway. But, with the lack of oxygen, muscles usually relax and the larynx opens, allowing water flow into the lungs.
A secondary or delayed drowning is likely the most common reason we see children in urgent care after a concern for drowning. Some children can develop lung injury up to 8 hours after a significant aspiration, but they are usually symptomatic after drowning, with coughing, wheezing, trouble breathing, lower oxygen levels than normal, or shortness of breath. A child without these symptoms after the drowning episode usually will not develop lung injury hours later. Furthermore, worsening lung function will occur hours after the injury, not days or weeks. If a child has a drowning episode of any severity and suffers progressive lung injury but did not require resuscitation and is acting fairly normally after the drowning, it is termed a nonfatal drowning. The progressive lung injury follows the same drowning pathophysiology, except that the amount of water aspirated into the lungs was not significant enough to cause more severe initial symptoms. The prognosis for minor drownings with progressive symptoms is usually excellent. Drownings with a poor prognosis are those that result in the requirement for CPR or signs of neurologic injury with a depressed level of consciousness immediately after the drowning episode.
