little girl swimming in pool


Some 700 American children under age 14 die of drowning each year. But when a child is pulled out of the water and revived, they may face life-threatening peril hours or days later as the body reacts. Experts discuss.

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  • Dr. Christopher Michos, emergency physician, St. Vincent’s Medical Center, Bridgeport, CT
  • Dr. Luis Torero, Division Chief, Pediatric Critical Care, Advocate Children’s Hospital, Oak Lawn, IL

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16-29 Secondary Drowning

Nancy Benson: Every year, about 700 children under age 14 die from drowning in the United States. And for every child who dies, another five suffer a near drowning serious enough to require hospitalization. Even if a child is revived, to see a tiny, lifeless body pulled out of the pool is one of the scariest things a parent can go through. And it can happen in a flash.

Christopher Michos: He was three years old. I’ll never forget it. Every year we visit Cape Cod, we go to the same place. I’m literally sitting you know, at the edge of the pool, never thinking that my young son would just spontaneously jump in the water and boom, right before my eyes, he jumped in, and I jumped in to grab him as he literally sank down to the bottom of the 8-foot-pool.

Benson: That’s Dr. Christopher Michos, an emergency physician at St. Vincent’s Medical Center in Bridgeport, Connecticut. He knows his son was lucky. Just having one’s back turned for a second can mean a child enters the water unnoticed. And over the summer, it happens a lot. For kids age one to four, drowning is responsible for more deaths than any cause except birth defects. In most cases, infants and toddlers are drowned in home swimming pools. But it can happen almost anywhere there’s water.

Michos: It’ll affect children, particularly very young children, under the age of five from pool accident or just unfortunate accidents involving toilets or even buckets of water that unfortunately children can fall in. Can you imagine the tremendous guilt that a parent would feel leaving their child briefly in a bath tub to turn and reach for a towel or maybe answer a phone or maybe go downstairs to answer the door? It can be just taking your eyes off for that brief second that can lead to a horrific catastrophe. But also pools; suddenly just turning your back. Parents have to be tremendously vigilant in keeping an eye on the children.

Luis Torero: Usually this time of year there’s so many people in a swimming pool just relaxing and having a good time and it’s hard to look at every single child. So, if that happens then a very short time is all that is necessary and then the child could near drown or drown. It could be very fast; it could be within a minute.

Benson: That’s Dr. Luis Torero, division chief of pediatric critical care at Advocate Children’s Hospital in Oak Lawn, Illinois. He says particularly when a child aspirates water, critical injury to the lungs can be rapid. According to the National Safe Kids Campaign, 92 percent of children who survive are discovered within two minutes of submersion. Michos agrees time is critical.

Michos: Outcomes can be very serious if the duration of submersion in the water is greater than five minutes. That seems to be the most critical factor that they’ve proven over studies. It’ll also depend upon the time to basic life support. The longer basic life support is not carried out, the worse outcome you have. If a prolonged CPR is being carried out in the field – that is also a bad predictor. So it’s hard to say one specific thing that you can say why some survive and why some don’t.

Benson: However, even when a child is safely revived after being submerged for a minute or two… They’re not out of the woods just yet. The child may be talking and seem perfectly okay. But the situation could turn deadly hours or even days later.

Torero: If you have lack of oxygen for a short period of time like for a minute or so, that can be enough of an injury to affect different organs. Especially the lungs in this case could initially respond well to what the people had the site do and then at the hospital they can show signs later on of injury from the brief time that there was lack of oxygen. And even though it might not show early on, it can cause inflammation and then what we call pulmonary edema which is basically the lungs get full of water from the body.

Benson: That’s why doctors often insist on hospitalizing children after a near-drowning incident… Even when the child looks perfectly alright. Doctors want to keep an eye on the child for so-called “secondary drowning,” when the lungs fill up with water from the body prompted by injury to the lungs.

Michos: It’s only a small amount of water ingested that can cause issues down the road and that’s certainly something that why you’re referring to this particular case. And certainly, if there’s any concern, the best place for any child or any patient that may have a possibility of deteriorating down the road is to observe. And in terms of hospitalization, most non-fatal drowning victims are admitted. There was a study once conducted regarding the pediatric patients that those that developed symptoms following a non-fatal drowning developed serious discoloring about seven hours after the immersion. So that’s why there is the concern to then monitor those patients for an extended period of time.

Torero: We keep watching the child, we could start noticing the saturations or oxygen in the blood is coming down, the work of breathing is starting to look a little more pronounced and babies are a little more upset and maybe sleepy. We decide to look a little more into it and we do an x-ray and the x-ray we see that there is something going on, the lungs are not looking as good as they did in the beginning. If they had an x-ray done early on, then they could progress into a severe state. There could be respiratory failure, that’s what we can call secondary drowning.

Michos: When breathing becomes an issue particularly with children because they rely so much on lung capacity for life, particularly younger children, if there’s any compromise to the breathing of a child that can lead to a very serious deterioration very quickly.

Benson: That can happen whether a child is in the hospital or not… And sometimes kids are pulled out of the water without paramedics or doctors ever hearing about it. So Torero says the first couple of days after a near drowning, parents should look at their child the same way doctors do.

Torero: Basically your baby starts to work ha rd to breathe. The baby’s a little more sleepy, irritable. Maybe some change in color of the lips or the nail bed, some blue tinge in those areas. But more than anything, it’s just you see the respiratory rate or the breathing rate increases. You see that some muscles that we normally don’t use to breathe start being very obvious, like the neck muscles or the muscles between the ribs pulling in or the building of muscles of babies are using them more because they’re having a hard time breathing.

Benson: But while doctors keep their eyes on the child who’s been nearly drowned, they can’t ignore the rest of the family… Especially parents who’ve tried so hard to keep their kids safe.

Michos: What I do deal with is the tremendous guilt, the immediate guilt that the parent feels when they’re bringing their child in from an accident like this. You know, “I just took my eyes off of him for once second” or “we never thought that this could happen” or “he was in his room and all of a sudden we couldn’t find him” and then the tragic event that they find the child in the pool. That’s the horrible feeling that a parent has and trying to witness that and to counsel that is very difficult because it is a tremendous emotional feeling that your son or daughter is critically ill and again, you could just turn your back for a brief second and tragedy happens.

Benson: And Michos says it can happen so fast that parents need to be much more vigilant than they think.

Michos: How many parents we see now a days with smart phones and checking emails and checking Facebook, when you’re in the pool or at the beach, this is the time to make sure your eyes are trained on your children at all times. So that way, you can protect them from any risks out there and hopefully everyone has a safe and enjoyable summer and I don’t have to see a poor drowning victim in the emergency department.

Benson: You can find out about all of our guests on our website…

Our production director is Sean Waldron.

I’m Nancy Benson.

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