- Experts warn that children may ‘drown’ hours after leaving the pool
By Tessy Igomu
FOR Tobi, swimming was no big deal. At 12, he was considered a champion among his peers.
He could do several laps without losing a breath. But during a swimming outing with friends, he accidentally inhaled some pool water. He coughed a bit, but few minutes later, he was back in the pool. Later at home, he appeared fine. But after dinner with his parents, he complained of tiredness and was tucked into bed by his mother.
Going to bed early was not typical of Tobi, as such, the development naturally disturbed his mother, who kept checking on him to see how he was faring. Minutes later, she was alarmed to find him gasping for breath. Expectedly, she rushed him to a children’s hospital down the road.
Tests later revealed that Tobi’s lungs were filled with water and in fact, he was gradually drowning. He was diagnosed with the phenomenon ‘dry drowning.’
How dry drowning occurs
For children, the allure of splashing in a pool could be tempting and irresistible. But the dangers of drowning hours after taking a dip are a reality that stares every parent in the face.
This might sound somewhat scary and unimaginable, but medical findings have revealed that a child can seem fine after getting out of a pool or body of water, but can start to have trouble breathing an hour or up to 24 hours later. The rest of the story is better left to imagination, if the situation is not immediately handled as an emergency.
That was the unfortunate case of Johnny Jackson, a 10-year-old American boy from South Carolina. He died from ‘dry drowning’ more than an hour after going swimming and walking home with his mother.
Johnny’s mother, Cassandra, while reliving her experience, said she never knew “a child could walk around, talk and speak with their lungs filled with water.”
His mother said she bathed him and he told her he felt sleepy. When she went to check on him later, she saw his face covered in a “spongy white material.” Unfortunately, by the time he got to the hospital, it was too late.
Naturally, most parents would readily defend that safety remains a top concern when it comes to their children hitting the water. But, according to WebMD, an online medical publication, sometimes it could happen when a child is struggling while swimming. It can as well be a result of something as simple as getting water in the mouth or getting dunked (dipped into water), or inhaling water during a bath.
Experts have warned that children, especially those under the age of five, stand the risk of what is known as dry drowning or secondary drowning out of water. The idea that a child could drown on dry land could be admittedly terrifying, and could make any parent cringe. But it is indeed very real.
According to the US Centre for Disease Control and Prevention (CDC), about 3,600 Americans died from drowning in 2005, including a small percentage that died up to 24 hours later because of water entering their respiratory systems. A significant number of the victims, the agency disclosed, were children who died after having a bath.
According to medical experts, with dry drowning, water never reaches the lungs. Instead, breathing in water causes a child’s vocal chords to contract and close up after the child had already left the water terrain. The airways remain shut, making it hard to breathe. A condition called pulmonary edema (fluid accumulation in the lungs that limits breathing) is said to occur next. In some cases, it is said to take up to 24 hours before the person shows signs of distress that can cause respiratory problems, brain injury, and in worst-case scenario, death.
There may be no symptoms
According to Emmanuela Obi, a paediatrician, in dry drowning, a child can look fine and the next moment, the same child is battling to hang on to life. She also disclosed that it could also occur hours after a child has had a bath and gulped in considerable amount of water. She warned parents or caregivers against putting a child under a shower and to avoid consistently pouring water on a child’s head.
She disclosed that in Nigeria, there were no specific statistics on how many kids die each year from dry drowning, adding that in her 14 years practice as a paediatrician, she had only seen one patient, who suffered from drowning that happened long after getting out of the pool. She admitted that it was usually a life-threatening scenario and advised parents who loved spending time at the pool or beach to be aware of the signs and symptoms.
According to Sarah Denny, a member of the American Academy of Paediatrics’ Council on Injury, Violence & Poison Prevention, and an attending physician in the Section of Emergency Medicine at Nationwide Children’s Hospital in Columbus, Ohio, dry drowning or secondary drowning doesn’t happen out of nowhere. For her, the warning signs would always be there. She warned: “No matter your child’s age, be on the lookout.”
Also Purva Grover, Medical Director of Cleveland Clinic Children’s Paediatric Emergency Departments, in a report published on USA Today, said: “It’s very unusual for the child to have absolutely no symptoms, but they may go to bed and in the middle of the night have trouble breathing. It takes a couple of hours for the fluid to emerge in the lungs.”
Some vital signs to look out for include coughing, chest pain, trouble breathing and feeling extremely tired. The child may also have changes in behavior such as such as irritability or a drop in energy levels, which could mean the brain isn’t getting enough oxygen, according to www.webmd.com.
Steps to take
The online medium says if a child has any signs of dry drowning, one must get medical help immediately. “Although in most cases the symptoms will go away on their own, it’s important to get him checked out,” the website noted.
Preventing dry drowning
The cheery news, however, is that this rare incident can be prevented. Experts say it boils down to being observant as a parent and identifying when a child is having trouble breathing, mostly about four to six hours after a visit to any body of water.
For Dr. Obi, the signs to look out for include persistent coughing or struggle to breathe or rapid-shallow breathing and nostril flaring.
“Any change in behaviour could be a sign. Also, if your child feels sick or acts too sleepy, 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. Similarly, a dip in oxygen level could cause your child to feel sick or dizzy. Vomiting is also a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen from persistent coughing and gagging. Parents should as a matter of urgency, immediately head for the nearest hospital.
“The child’s vital signs, oxygen level, and work of breathing will be checked by a doctor. Patients with more mild symptoms just need careful observation, and in more serious cases, the doctor may also do a chest x-ray or give oxygen. In cases of respiratory failure, or when a child can no longer breathe on their own, extra support is needed. The goal will be to increase blood flow in the lungs and get the child breathing well again,” she explained.
Navy Captain Femi Daramola (retd) noted that such conditions that could possibly lead to dry drowning could happen to both the young and old, and could be caused by bubbles of water missing their route from the lungs and travelling to a point where they build up pressure capable of shutting oxygen supply to the brain.
He explained that diving to about 10metres causes the lungs to collapse to half size its size due to under water pressure, adding that the deeper the depth, the more compressed the lungs become and staying too long could lead to Nitrogen Toxicity (excess nitrogen), which is capable of making a swimmer delirious. He noted that a swimmer that had been underwater for a while must come up gradually and observe what is called stoppages, at intervals, to avoid damaging the lungs.
“If a swimmer or someone that jumped from a depth emerges immediately out of panic to the surface, the lungs can burst as air which had been compressed escapes. During this process, air bubbles might get to the spleen and if it escapes to the brain, it can cut off oxygen supply; a phenomenon known as ‘air embolism.’ By the time the air from the lungs misses its route, the bubbles can travel up to the brain and block a vessel, cutting off oxygen supply. This can lead to death and could take hours before it actually occurs,” he said.
The retired naval captain stressed the need for enforcement of pool safety rules and the need for children to always wear floatation devices while in water. He also warned against leaving standing water where children could get into or dip their heads.
A swimming instructor, Adetokunbo Olorungbemi, attached to the Nigerian Navy Special Boat Service (SBS), advised that kids should be encouraged to take swimming lessons, noting that kids who were comfortable and skilled at moving around in the water were less likely to go under and take in water. He noted that the best age to start swimming lessons for children was from seven months, adding that by then, they had learnt what he called familiarisation.
Olorungbemi advised that before children are admitted for swimming lessons, their medical history must be known to determine if they are asthmatic or epileptic. He also advised that children should be trained under competent supervision.