Drowning vs. Dry Drowning

As the summer comes to a close, we thought that we would take a moment to discuss the topic of “Dry Drowning”. Every summer, this concept receives a lot of media attention and causes significant distress among many parents. We hope that the following discussion helps to debunk some of the misinformation in the media, as well as provide some evidence-based knowledge to allay fears.

The simplest place to start our discussion is with the medical definition for drowning. This medical definition is “the process of experiencing respiratory impairment from submersion/immersion in liquid”. (Definition of Drowning: A progress Report. Bierens J, Drowning 2e Berline: Springer, 2014) One of the following outcomes occurs from drowning. (1) death (2) injury without death (3) no injury or illness following drowning.

In the medical community, “dry drowning” is not considered an accepted medical condition. This would also include the terms “near drowning” or “secondary drowning”.  The main issue is that the media and lay person associate drowning with death. It is important that we change our way of thinking so that we see drowning as a process where there is a spectrum of outcomes (which we listed above).  An example that may make this more understandable is that a person may have a heart attack and still survive (with or without major consequences). This is the same way that a person could drown and still survive with or without major consequences.

Dry Drowning does not have an actual medical definition. The term came about when people described an aspect of drowning that found that the lungs of individuals who had drowned did not have water in them. 10-20% of the time, very little water every enters the lungs. This equates to about one ounce of water entering the lungs of a 30lb child.

Severe Symptoms

The main issue when a child is submerged under water is the lack of oxygen. The treatment would be to start CPR immediately. If the CPR is successful, and the child starts breathing again, then the little amount of water that did enter the lung is absorbed by the body with no issue. It may also cause coughing that may get better or worse over the next few hours. There are instances where respiratory symptoms such as coughing and comfortable breathing may worsen after a drowning incident. These individuals should seek medical help. There is usually a 2-3 hour period where a person will either improve drastically or worsen.

Minimal Symptoms

Parents often ask “how much is too much” in terms of submersion under water or inhaling water. Minimal symptoms are what one experiences from taking a drink at dinner and feeling like it has “gone down the wrong pipe”. You will sputter and cough and clear it over a few minutes. If you feel that your child is experiencing symptoms that are worse than “the wrong pipe scenario”, and they are not improving over several minutes, then you can seek medical attention. The good news is that it is RARE for minimal symptoms to actually progress to death. The symptoms will progress and worsen and give you time to seek medical attention.

Warning Signs

Here are warning signs for drowning or submersion/immersion in liquid: Difficulty breathing, excessive coughing, foaming in mouth, and not acting normally.

Prevention

Drowning is the leading cause of preventable death in pediatrics. This is a serious risk, and one that should be taken seriously. We encourage all children to get swim lessons if able. Non swimmers should wear life jackets, and toddlers should have touch supervision. A pool should have fencing on four sides with locking gates. There should be continuous supervision at all times when children are in the water, even if a life guard is present.

Exciting News!

We are pleased to announce that we have a new physician joining our staff this August! We are taking this opportunity to introduce Dr. Rebecca LePage.

About Dr. LePage:

Dr. LePage completed her undergraduate education at Dartmouth College where she graduated cum laude with a B.A. in Psychology. She received her medical degree from Georgetown University and subsequently completed her pediatric residency at the Mount Sinai Medical Center. Dr. LePage is a board certified physician and a fellow of the American Academy of Pediatrics. While she loves working with all children, she is particularly interested in working with children with medically complex diagnoses, developmental disabilities or behavioral challenges. Dr. LePage lives in Wilton with her daughter, twin sons and dog.  She is an avid reader and enjoys dancing, kickboxing and traveling.

Screen Time vs. Play Time

Technology is an ever evolving intricate part of our lives, especially our children’s lives. There are always positives and negatives that come out of advancing technology. One of the negative impacts is the amount of time that children spend on screens. Screen time is taking over “free” play time for many children.

Many parents are at a loss as to the long term ramifications of screen time, as well as how to provide reasonable limits for their children. The World Health Organization recently issued guidelines for young children under the age of five years old. According to these guidelines, they advise that children under the age of five spend less time in front of a screen. Parents should focus on an active lifestyle that promotes playtime rather than sedentary screen time.

The new guidelines initiated by the World Health Organization focuses its efforts and studies on physical activity, sedentary behavior, and quality of sleep for children under the age of five. The World Health Organization experts evaluated the adverse effects on young children of insufficient sleep, and the time invested in watching screens. These experts concluded that enhancing physical activity, reducing sedentary time, and securing quality sleep in young children will promote and strengthen both their physical and mental health as well as their overall wellbeing. Increasing physical activity and quality of sleep will inhibit obesity, diabetes, and cardiovascular diseases. The World Health Organization also recommends shifting screen time to quality sedentary time. Quality sedentary time includes reading and completing puzzles as this encourages proper child development. Furthermore, establishing these guidelines during the first five years of life is critical for children’s developmental, physical, and mental health.

World Health Organization recommendations for infants (up to one-year-old)

• Be physically active several times throughout the day (includes floor-based play, prone position for those children not yet mobile).
• Not be restricted for more than one hour at a time (including strollers, high chairs, or on caregiver’s back)
• Avoid screen time, and encourage reading and storytelling when sedentary.
• Encourage fourteen-seventeen hours of sufficient sleep for zero-three months and support twelve–sixteen hours of adequate sleep for ages four–eleven months. Additionally, we should promote naps to encourage overall quality of sleep for these ages.

World Health Organization recommendations for children ages one-two years:

• Be physically active for at least three hours throughout the day (including moderate to high-intensity physical activity.
• Not be restricted (including strollers, high chairs, or on caregiver’s back) or sit for more than one hour at a time.
• Avoid screen time for one-year-olds. Limit to one hour of screen time for ages two years old. Encourage reading and storytelling when sedentary for both ages.
• Encourage eleven-fourteen hours of sufficient quality sleep as well as including nap time.

World Health Organization recommendations for children ages three-four years:

• Be physically active for at least three hours throughout the day (including sixty minutes of the allotted time as moderate to high-intensity physical activity).
• Not be restricted for more than one hour at a time (including strollers, high chairs, or on caregiver’s back)
• Limit to one hour screen time for ages three to four. Encourage reading and storytelling when sedentary.
• Promote ten-thirteen hours of sufficient sleep and may include nap time.